Appeals Analyst

Bind Minneapolis , MN 55415

Posted 2 weeks ago

Bind was formed in 2016 by veteran health insurance innovators passionate about making health insurance personal - with the clarity, flexibility and power people deserve.

Want to move mountains?

Bind took the old model of health insurance apart and is rebuilding it - from floor to ceiling, from studs to rafters. We're not iterating a tired design or nudging a change-resistant industry, we're delivering what people want now - clear prices, timely support, personal choice and flexibility and an awesome, intuitive experience.

Where different wins.

Help build different and make a difference. Become a Binder and help us revolutionize health insurance.

Appeals Analyst


We are adding an Appeals Analyst to our growing team! The Appeals Analyst ensures member appeals are responded to in a professional and customer-focused manner and completed according to state and federal mandates and within SLAs. Perform research that leads to the resolution of assigned cases, management of appropriate follow-up activities and ensures accurate and timely reporting and documentation of cases; analyzes and reports on trends and supports process and experience improvement. Focus, enthusiasm, and a dedication to excellence are all personal characteristics highly valued at Bind.


  • Perform system and related investigation into appeals by researching sources to establish facts for case review.

  • Resolve or provide recommendations on appeals by applying critical thinking, sound judgment; interprets and applies benefit plan documents, internal policies and procedures, and state and federal guidelines.

  • Consult and present information to internal departments, committees and senior management as needed to resolve high profile, complex appeals and complaints.

  • Coordinate additional follow up activities with appropriate teams, ensure resolution has occurred, documentation is complete, required time frames are met, and proper communications.

  • Document processes and findings within appropriate case logs, and other internal tracking systems, and maintain grievance and appeal case files as required by programs, state and federal mandates.

  • Provide comprehensive and timely responses to member issues, including those involving sensitive or highly visible issues; prepares communication of decisions in plain written language following all applicable state and federal mandates

  • Interpret and apply department policies and procedures and assist with applicable laws, rules, and regulations; ensure process and operation compliance and receive guidance within these areas as needed.


  • Bachelor's degree in related field and at least five (5) years of combined progressive experience in health plan member service center, escalated service team and appeals; or equivalent education and experience.

  • Experience responding to member complaints, grievances and appeals.

  • Knowledge of principles, practices and techniques within health care plan operations.

  • Experience in research and analyzing medical details and claim information.

  • Methods to research medical information and claim details.

  • The administration and oversight of plan programs, policies and procedures.

  • Health care insurance programs and coordination.

  • Develop and apply case management/appeals approaches or concepts.

  • Recommend and/or resolve questions and appeals.

  • Perform professional-level appeal duties in a variety of assigned areas.

  • Project management principles and practices.

  • Applicable laws, codes and regulations.

  • Process improvement principles and programs.

  • Ability to work independently and maintain a high level of initiative.

  • Handle confidential information with discretion.

  • Perform multiple concurrent projects with firm deadlines.

  • Communicate effectively and build relationships at all levels of the organization.

  • Be flexible, adapt to change.

  • Present and coordination information across multiple groups.

  • Serve as a team member and own the development and management of projects.

  • Operate in both a team and individual contributor environment.

  • Interpret, apply and explain applicable laws, codes and regulations.

  • Prepare functionals reports, correspondence and other written materials.

  • Use initiative and independent judgment within established department guidelines.

Preferred Qualifications

  • Experience with Hyland or Kiriworks A&G tracking system

  • Startup experience

  • Working in an ambiguous, fast-paced environment

  • Agile, ready to change direction on the fly

What We're Offering

  • Chance to join a new tech start-up aiming to fix the healthcare industry

  • Empowerment to shape new solutions disrupting healthcare while providing benefits and choice to its members

  • Flexible work-from-home schedule to support work-life balance

  • Opportunity to work with people who are motivated to go to work every day and make a difference

  • Competitive pay, generous PTO, and the opportunity to be a part of a new health insurance plan powered by the consumer, you!

Diversity creates a healthier atmosphere. Bind is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Bind is a drug-free workplace.

Bind sponsors H-1B visas for current H-1B visa holders on a limited basis, other visa sponsorship not available.


icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Claim Appeals Specialist

Tactile Systems Technology, Inc.

Posted 2 weeks ago

VIEW JOBS 4/27/2021 12:00:00 AM 2021-07-26T00:00 Position Summary The Claim Appeals Specialist is responsible for researching and addressing claim issues related to medical necessity in which a request for additional information or denial of payment has been received. This position works closely with payers and our Billing and Collections teams to effectively address the denial/request for additional information with supporting clinical information and persuasive writing in effort to secure reimbursement. Accountabilities & Responsibilities * Utilize resources to effectively research denial/requests for additional information * Evaluate clinical information and supportive documentation prior to payer response * Prepare persuasive response to request for information or appeal based on supporting clinical information and available studies/research * Prepare clear and concise persuasive statements of medical necessity from a clinician's perspective * Monitor denial and appeals information for payer, provider, or departmental trends. Routinely report to management regarding trends and recommends process improvement initiatives. * Generate denial and appeal tracking reports for management and departments * Maintain compliance with all appropriate regulatory requirements including HIPAA * Other duties and projects as assigned Education & Experience Required: * Bachelor's degree or equivalent relevant work experience * 1-3 years' experience writing commercial payer claim appeals * 1+ years of commercial billing experience Preferred: * Clinical background * Previous experience in medical device industry or health insurance * Experience with Brightree software Knowledge & Skills * Experience with Microsoft Word, Excel, and Outlook * Understanding of health insurance methodologies (coding, coverage, prior authorizations, clinical criteria and payments) * Exceptional attention to detail and written communications skills with emphasis on persuasion and clinical knowledge * Excellent analytical and research skills * Strong strategic thinking ability with bias towards action/execution * Ability to organize and manage workload with limited oversight Competencies * Written Communication * Influencing * Persuasion * Organizational Skills * Priority Setting * Multi-tasking * Relationship Building * Problem Solving * Process Management It is the policy of Tactile Medical to provide equal opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Tactile Medical will provide reasonable accommodations for qualified individuals with disabilities. Tactile Systems Technology, Inc. Minneapolis MN

Appeals Analyst