About The Role Skill required: Claims Appeals - Claims Administration

Designation: Health Admin Services Analyst

Qualifications:BBA/BCom/BMS

Years of Experience:3 to 5 years

Language - Ability:English(Domestic) - Intermediate
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What would you do The SME – Appeals Grievance (AG) serves as a functional expert responsible for providing guidance on complex cases, ensuring regulatory compliance, and supporting process improvements. This role acts as a bridge between operations, quality, and leadership by offering expertise in appeals and grievance handling, resolving escalations, and enhancing team performance.Subject Matter Expertise:Act as the primary point of contact for complex and escalated appeals and grievance casesProvide guidance on case handling, policy interpretation, and decision-makingEnsure accurate application of guidelines and business rulesCase Review Resolution:Review and validate high-risk, sensitive,



or complex casesEnsure proper documentation, investigation, and resolution of appeals and grievancesSupport root cause analysis for recurring issuesCompliance Quality Assurance:Ensure adherence to regulations from the Centers for Medicare Medicaid Services (CMS) and internal policiesMaintain compliance with Health Insurance Portability and Accountability Act (HIPAA) for data security and confidentialityConduct quality audits and provide detailed feedback to improve accuracyAssist in preparing for internal and external auditsTraining Knowledge Sharing:Train current hires and provide ongoing training to team membersDevelop and update standard operating procedures (SOPs) and training materialsShare updates on policy changes, regulatory updates, and process improvementsStakeholder Support:Collaborate with cross-functional teams (claims, enrollment, billing, providers)Act as escalation support for team l

📌 Health Admin Services Analyst (Navi Mumbai)
🏢 Accenture Solutions
📍 Navi Mumbai