Health Admin Services Analyst

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

About Accenture

Accenture is a global professional services company with leading capabilities in digital, cloud and security.Combining unmatched experience and specialized skills across more than 40 industries, we offer Strategy and Consulting, Technology and Operations services, and Accenture Song— all powered by the world’s largest network of Advanced Technology and Intelligent Operations centers. Our 784,000 people deliver on the promise of technology and human ingenuity every day, serving clients in more than 120 countries. We embrace the power of change to create value and shared success for our clients, people, shareholders, partners and communities.Visit us at www.accenture.com What would you do? The SME – Appeals & Grievance (A&G) 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 cases Provide guidance on case handling, policy interpretation, and decision-making Ensure accurate application of guidelines and business rules Case Review & Resolution:

Review and validate high-risk, sensitive, or complex cases Ensure proper documentation, investigation, and resolution of appeals and grievances Support root cause analysis for recurring issues

Compliance & Quality Assurance:

Ensure adherence to regulations from the Centers for Medicare & Medicaid Services (CMS) and internal policies Maintain compliance with Health Insurance Portability and Accountability Act (HIPAA) for data security and confidentiality Conduct quality audits and provide detailed feedback to improve accuracy Assist in preparing for internal and external audits Training & Knowledge Sharing:

Train new hires and provide ongoing training to team members Develop and update standard operating procedures (SOPs) and training materials Share updates on policy changes, regulatory updates, and process improvements

Stakeholder Support:

Collaborate with cross-functional teams (claims, enrollment, billing, providers) Act as escalation support for team leads and managers Communicate effectively with internal and external stakeholders regarding case status and resolutions