Clinical Appeals Analyst
Blue Cross NC(1 month ago)
About this role
This position is responsible for analyzing, researching, and resolving complex, non-routine member and provider appeals and grievances for Blue Cross NC. The role ensures compliance with state, federal, and NCQA requirements while addressing customer concerns to achieve timely resolution and satisfaction. The position reports to the Manager, Nursing or Team Leader, Medical and requires an active North Carolina nursing license.
Required Skills
- Clinical Consultation
- Appeals Analysis
- Case Management
- Documentation
- Claim Adjustment
- Regulatory Compliance
- Telephone Communication
- Vendor Coordination
Qualifications
- Registered Nurse (NC)
- Licensed in North Carolina
- 3 Years Clinical Experience
About Blue Cross NC
bluecrossnc.comBlue Cross NC makes health insurance easy. Discover employer, individual, family, Medicare & Medicaid plans from Blue Cross NC. Better care starts here.
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