UST HealthProof partners with health plans to deliver integrated operations solutions. With over 4,000 employees worldwide, we focus on simplifying healthcare administration and ensuring equitable access.

Role Overview:

The Appeals and Grievances Analyst ensures cases are handled accurately and in compliance with CMS regulations. Key duties include processing end-to-end cases, preparing summaries, coordinating assignments, and ensuring timely completion. Analysts also document findings, recommend case resolutions, and participate in quality improvement and compliance initiatives.

Key Responsibilities:

Process and document appeals and grievances following company and CMS guidelines Investigate cases, prepare summaries, and support operational excellence Assign and coordinate case review tasks Identify and escalate process or system issues Collaborate with IT for process improvements Participate in audits and compliance committees

Qualifications:

Bachelor’s degree required; Master’s preferred (or equivalent experience) Certification in related field preferred Experience in grievances, appeals, and CMS regulations, especially with Medicare Advantage plans Knowledge of claims, authorizations, and industry rules

Skills:

Strong analytical, organizational, and communication abilities Problem-solving and data analysis skills Ability to work under deadlines and communicate across departments