Business Operations Analyst I

Job Summary:

The IQA Appeals Specialist is responsible for managing complex appeals. This position requires advanced analytical skills, strong legal and medical knowledge, and the ability to navigate high stakes claim scenarios.

Key Responsibilities:

• Review and evaluate complex appeals cases involving disputed workers’ compensation claims.
• Draft detailed and persuasive appeal responses and documentation.
• Collaborate with legal counsel, gather necessary documentation, and support case resolution.
• Track and manage appeal timelines to ensure all deadlines are met.
• Identify trends and recurring issues in appeals and recommend process improvements.
• Maintain accurate and thorough documentation in the claims management system.

Qualifications:

• 5+ years of experience in workers’ compensation claims or appeals.
• Strong understanding of workers’ compensation regulations, medical terminology, and legal processes.
• Excellent written and verbal communication skills, with the ability to draft clear and persuasive documentation.
• High attention to detail and ability to manage multiple complex cases independently.
• Proficient in claims management systems and Microsoft Office Suite.
• Strong analytical and problem-solving skills.

Preferred Qualifications:

• Certification in Workers’ Compensation (e.g., CWCP, WCCA/WCCP).
• Experience working with multi-state WC programs or in a TPA, insurance carrier, or medical cost containment company.