Appeals Analyst

Experian is a global company in data services, helping organizations and consumers manage risk and make informed decisions. We empower individuals and businesses at important life moments, from purchasing a home to expanding customer bases. With over 125 years of experience, we specialize in data gathering, analysis, and fraud prevention. Our 21,700 employees across 30 countries are dedicated to innovation and creating opportunities for a better tomorrow. Recently ranked the fifth-best company to work for in Costa Rica, we prioritize inclusive culture, employee well-being, and career development. Join us at www.experian.com/careers to be part of our team.

The Appeals Analyst will contribute in ensuring accurate and timely reimbursement by reviewing underpaid claims, identifying appeal opportunities, and partnering with payers and networks to resolve discrepancies. You will use a variety of tools, including contract management systems, to evaluate explanations of benefits (EOBs), analyze contract terms, prepare appeals, and monitor outcomes. The Appeals Analyst collaborates with our teams to share trends, support process improvements, and uphold the highest standards of confidentiality and compliance within a managed care environment. You will report to the Appeals Director.

• Bachelor's degree in a related field or equivalent combination of education and relevant experience.
• At least two years of experience working with managed care claims and appeals in a healthcare professional services setting.
• Proficiency with Microsoft Office applications and familiarity with digital and remote office tools.
• Knowledge of medical terminology, managed care contracts, and the healthcare reimbursement environment.
• Experience with practice management systems (PMS), EOB imaging systems, and contract management software.
• Ability to work effectively in a production-focused environment while managing priorities with attention to detail.

Responsibilities

• Analyze underpaid or denied claims using Contract Manager tools and other available resources to identify appeal opportunities.
• Review EOBs, contract terms, and member information to verify payment accuracy and determine the appropriate appeal path.
• Prepare and submit written or phone-based appeals, ensuring clear communication.
• Track appeal activity, outcomes, and payment adjustments within the Contract Manager application.
• Partner with payers, networks, and company partners to resolve issues, monitor trends, and support continuous improvement efforts.
• Maintain strict confidentiality of medical records and patient data while participating in ongoing professional development related to managed care reimbursement.

Benefits/Perks:

Our benefits include: Medical, life and dental insurance, Asociacion Solidarista, International Share Save Plan, Flex Work/Work from home, Paid time off, Annual Performance Bonus, Education Reimbursement, Family Bonding, Bereavement Leave, Referral Program, and more.

 

This is a fully remote job opportunity. #LI-Remote

Our uniqueness is that we celebrate yours. Experian's culture and people are important differentiators. We take our people agenda very seriously and focus on what matters; DEI, work/life balance, development, authenticity, engagement, collaboration, wellness, reward and recognition, volunteering... the list goes on. Experian's people first approach is award-winning; Great Place To Work™ in 24 countries, FORTUNE Best Companies to work and Glassdoor Best Places to Work (globally 4.4 Stars) to name a few. Check out Experian Life on social or our Careers Site to understand why.

 

Experian is proud to be an Equal Opportunity and Affirmative Action employer. Innovation is an important part of Experian's DNA and practices, and our diverse workforce drives our success. Everyone can succeed at Experian and bring their whole self to work, irrespective of their gender, ethnicity, religion, colour, sexuality, physical ability or age. If you have a disability or special need that requires accommodation, please let us know at the earliest opportunity.