Arthur Grand Technologies Inc

Role Description The Grievance and Appeals (G&A) Claims Analyst is responsible for the end-to-end processing of appeals, grievances, and medical claim disputes received from members, providers, and regulatory agencies. This is a high-level analytical role that requires "thinking on your feet" to resolve a backlog of medical claim cases. - Conduct deep-dive research into internal/external resources. - Review contracts and apply complex rules to determine if a claim is acceptable. - Facilitate managerial-level conferences and negotiate resolutions. - Document every step of the process. - Communicate final decisions via formal written correspondence that meets strict corporate and regulatory accuracy guidelines. Qualifications - High-Level Analytical & Logical Mindset: Ability to examine facts and contextual information to make confident, assertive, and persuasive decisions. - Advanced Claims Expertise: Proven experience reading, analyzing, and reviewing claims at a high level. FACETS or NASCO experience is a significant advantage. - Superior Communication: Outstanding verbal skills for conferences and expert-level writing skills for formal documentation. - Research & Logic: Ability to interpret contracts, apply policies/procedures, and structure thorough, logic-based responses. - Fast-Paced Delivery: Comfortable managing tight deadlines and high-quality standards in a remote environment. - Technical Proficiency: Strong PC skills, including the MS Office Suite and the ability to navigate multiple complex databases simultaneously. - Confidentiality: High regard for protecting member, employee, and corporate information. - Professional Background: Previous experience in a concierge or high-end customer service setting (beyond standard CSR roles). Requirements - Legal Background: Experience working in a legal setting, paralegal experience, or contract review is a major plus. - Subject Matter Expertise: Background in research and formal writing. - Bachelor’s Degree Required. Preferred Majors: English/Writing, Health Care Administration, History, Juris Doctorate (JD), Paralegal Studies, or Political Science. Benefits - Market-relevant benefits. - Opportunities for professional growth.