Grievance and Appeals- Quality Analyst

Are you a highly analytical and detail-oriented individual with a passion for quality improvement? Aetna is seeking a Grievance and Appeals- Quality Analyst to join our team and play a crucial role in ensuring our members receive the best possible care and service. In this role, you will be responsible for reviewing and analyzing appeals and grievances to identify trends and areas for improvement, ultimately contributing to the overall success of our organization. We are looking for someone with excellent communication skills, a strong background in data analysis, and a deep understanding of healthcare regulations. If you are driven, proactive, and dedicated to making a positive impact, we invite you to apply for this exciting opportunity.

1. Review and analyze appeals and grievances to identify trends and areas for improvement.
2. Communicate findings and recommendations to internal teams to drive quality improvement initiatives.
3. Collaborate with cross-functional teams to develop and implement strategies for addressing identified issues.
4. Ensure compliance with healthcare regulations and company policies.
5. Conduct root cause analysis on identified issues and develop action plans to prevent future occurrences.
6. Utilize data analysis tools and techniques to track, report, and present data on grievances and appeals.
7. Monitor performance metrics and identify opportunities for process improvement.
8. Stay up-to-date on industry trends, regulations, and best practices related to grievances and appeals.
9. Provide guidance and support to internal teams on grievance and appeals processes.
10. Participate in quality improvement projects and initiatives as assigned.
11. Maintain accurate and detailed records of all activities and findings.
12. Foster a culture of continuous improvement and quality across the organization.
13. Act as a subject matter expert on grievance and appeals processes and regulations.
14. Communicate with members, providers, and other stakeholders to resolve issues and answer inquiries related to grievances and appeals.
15. Train and mentor new team members on grievance and appeals processes and procedures.

According to JobzMall, the average salary range for a Grievance and Appeals- Quality Analyst in Ohio, USA is $50,000 to $70,000 per year. This can vary depending on factors such as location, experience, and specific job duties.

Aetna Inc. is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare. Since November 28, 2018, the company has been a subsidiary of CVS Health.