Health Admin Services Analyst

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

• Technology and Operations services, and Accenture Song” all powered by the world's largest network of Advanced Technology and Intelligent Operations centers.

  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 new 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 leads and managersCommunicate effectively with internal and external stakeholders regarding case status and resolutionsProcess Improvement Reporting:Identify process gaps and recommend improvementsAnalyze trends in appeals and grievances to reduce errors and complaintsSupport reporting on quality metrics, compliance, and operational performance

  What are we looking for Strong expertise in appeals and grievance processesIn-depth knowledge of healthcare regulations and complianceExcellent analytical and problem-solving skillsStrong communication and training abilitiesAttention to detail and decision-making capabilityAbility to handle complex and sensitive cases

  Roles and Responsibilities:

• In this role you are required to do analysis and solving of lower-complexity problems

• Your day to day interaction is with peers within Accenture before updating supervisors

• In this role you may have limited exposure with clients and/or Accenture management

• You will be given moderate level instruction on daily work tasks and detailed instructions on new assignments

• The decisions you make impact your own work and may impact the work of others

• You will be an individual contributor as a part of a team, with a focused scope of work

• Please note that this role require you to work in US Shift time. No morning or rotational shifts

  QualificationBBA,BCom,BMS