Clinical Appeals Analyst job responsibilities are inclusive but not limited to the following: responsible for the analysis, research and completion of complex, non-routine appeals and grievances within the company. Ensure timeliness, quality and efficiency in all work to comply with mandated North Carolina Department of Insurance {NCDOI} and National Committee for Quality Assurance {NCQA} and Federal requirements. Ability to research and problem solve, strong medical knowledge, ability to make concise, independent and defensible decisions in often high pressure situations, excellent analytical planning and problem solving skills, managed care experience.