UST is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members’ well-being.

With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve affordable health care for all. We have a strong global presence and a dedicated workforce spread across the world. Our brand is built on the strong foundation of simplicity, integrity, people-centricity, and leadership. We stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively.

As an Appeals & Grievances Analyst, you will manage and resolve appeals and grievances submitted by members, providers, and regulatory agencies. This role requires a deep understanding of Medicare Advantage regulations, client contracts, excellent analytical skills, and a commitment to ensuring compliance.

Review and analyze appeals and grievances to determine appropriate resolutions Ensure compliance with CMS (Centers for Medicare & Medicaid Services) regulations and guidelines, and client specific rules Conduct thorough investigations, including gathering and reviewing medical records, provider documentation, and member information Prepare detailed case summaries and decision letters Communicate effectively with members, providers, and regulatory agencies to resolve issues. Maintain accurate and up-to-date records of all appeals and grievances Identify trends and provide recommendations for process improvements Collaborate with internal departments to ensure timely and accurate resolution of cases  Ability to work in a fast-paced production environment

Qualifications:

Bachelor's degree in healthcare administration, nursing, or a related field an advantage but not required Minimum of 2 years of experience in Medicare Advantage or Medicare-related field such as Claims and/or UM. In-depth knowledge of CMS regulations and guidelines Strong analytical and problem-solving skills Excellent written and verbal communication skills Ability to work independently and as part of a team Strong attention to detail and organizational skills 2 years of appeals and grievances experience preferred Medical billing / coding knowledge an advantage Amenable to working nightshift