Harbor Health is hiring an Appeals & Grievances Analyst to monitor and improve complaint, grievance, and appeal operations for its Texas commercial health plans. The role focuses on regulatory compliance, trend/root-cause analysis, audit reporting, and data-driven operational improvements.
What you’ll do
Monitor and analyze complaint, grievance, and appeal operations
Track regulatory turnaround times and compliance deadlines
Analyze trends and root causes of appeals and grievances
Manage audit reporting and validation
Support data integrity and operational improvements
Develop reporting solutions to replace manual tracking logs
What you’ll need
Bachelor's degree in healthcare analytics, HIM, business, statistics, public health, or related field (or equivalent healthcare experience)
3-5 years managed care/health plan experience, with 2+ years in Appeals & Grievances, compliance reporting, or complaint analytics
Understanding of commercial health insurance structures, including Large Group and ACA/Marketplace plans
Knowledge of state/federal A&G reporting, complaint taxonomies, statutory TAT standards, and audit universes (CMS, DOI, NCQA)
Experience with AxisCore platform and health plan data/workflows
Advanced Excel/Sheets skills, dashboard creation, and relational database querying
Original job description
Harbor Health is seeking an Appeals & Grievances Analyst to monitor, analyze, and improve complaint, grievance, and appeal operations for its Texas commercial health plans. The role tracks regulatory turnaround times, analyzes trends and root causes, manages audit reporting, and supports data integrity and operational improvements.Bachelor's degree in…