Lead Appeals Analyst

About the role

The Lead Appeals Analyst position at Covered California is seeking an experienced problem-solver with a passion for customer relations and healthcare policy. Your responsibilities will involve resolving customer appeals, escalations, and administrative processes, leveraging your expertise in the insurance or healthcare industry, and ensuring compliance with the Affordable Care Act.

Responsibilities

• Research and analyze complex customer issues
• Prepare well-crafted statements and recommendations
• Implement effective resolutions for identified issues
• Thrive in customer-facing environments
• Familiarity with CRM systems like Salesforce to maintain customer information
• Proficiency with Microsoft Office applications

Qualifications

• 2+ years of experience in the insurance/healthcare industry working on customer appeals, escalations and/or complaints
• 2+ years of experience interpreting State and Federal laws, Regulations and/or policies
• 1+ year of experience working with ACA-related policies, programs, or initiatives
• 2+ years of experience presenting information verbally and in writing, preparing written statements of position, recommendations, reports and/or findings in a professional setting
• 2+ years of experience in customer service or call center and familiarity with Customer Relationship Management systems like Salesforce or similar platforms
• 2 + years of experience using Microsoft Office Suite and Adobe Acrobat Professional to prepare reports, compile and analyze data, prepare presentations, and collaborate across teams using Teams, Webex or other communication platforms

Benefits

Covered California offers a comprehensive benefits package including healthcare, retirement and savings, work-life services, leave benefits, and work-life balance. Visit this link for more details.