Deal with clients who want to dispute or appeal a rejected insurance claim.
What does an Appeals Analyst do?
Appeals Analysts work in health insurance, dealing with clients when they want to dispute or appeal a rejected insurance claim.
The world of health insurance seems basic at first-find a health plan, and then a primary Doctor covered by that plan. However, add to this tons of different providers, specialists not covered by anyone, and guidelines written in a strange, nonsensical version of English. It’s a confusing world, the job of an Appeals Analyst is to understand it (or at least enough so they can determine what is and isn’t covered by their agencies).
When a claim gets disputed, the first thing you do as an Appeals Analyst is investigate. You track down all paperwork that details what procedures were done, where, and for how long. You also look for information on things like eligibility, payment schedules, and state or federal regulations.
If the claim needs a clinical eye, you send it off for another Doctor to review and let you know if things were handled correctly. The information you gather then lets you decide, based on strict company policy, which appeals should be accepted and which should be denied.
There’s a lot of customer service in this job. You not only deal with the appealing patient but also with Doctors, Billing Specialists, and anyone else who can help you figure out what happened in the case. You occasionally need to give bad news to patients, and should be able to handle stressed-out people who are facing big insurance bills.