- Elevance Health (Meridian, ID)
- **Title: Grievance/ Appeals Representative I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 ... miles of one of our PulsePoint locations. The **Grievance/ Appeals Representative I** is responsible for reviewing, analyzing and processing claims in accordance… more
- The Cigna Group (Bloomfield, CT)
- …limited to:** + Ability to differentiate different types of requests Appeals , Grievances, coverage determination and Organization Determinations in order to ensure ... documents, correct appeal types, timeframes and what is being appeals + Assign priority and internal due date based...criteria for reviewing and making decisions on all non-clinical appeals and validating the accuracy of all received information… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** Appeals and Grievances Representative supports the Operations Department and the Appeals and Grievances team in a ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
- Catholic Health Services (Melville, NY)
- …Catholic Health was named Long Island's Top Workplace! Job Details The Appeals and Authorization representative will perform activities to resolve authorization ... denials for ambulatory practices, and facilitate appeals for hospital based services. SPECIFIC RESPONSIBILITIES AND DUTIES...to the practices detailing total denials and status on appeals . Prepare appeals for claims the practices… more
- Office of General Counsel (Washington, DC)
- …the Department in affirmative litigation before HUD's Office of Hearings and Appeals . Representative matters include civil money penalty actions, Program Fraud ... Civil Remedies Act actions, suspensions and debarments, and actions on behalf of the Mortgagee Review Board. Work with the Department of Justice and HUD's Office of Inspector General (for matters in federal courts) to litigate civil cases based on the… more
- Commonwealth of Pennsylvania (PA)
- Appeals Referee Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/4709570) Apply Appeals Referee Salary $75,678.00 - $114,915.00 Annually ... of Labor & Industry is excited to welcome an Appeals Referee to our dedicated team! The primary focus...B. I have experience as a legal or non-legal representative of parties to quasi-judicial administrative hearings conducting direct… more
- Conduent (Hamilton, NJ)
- …a culture where individuality is noticed and valued every day. Fair Hearing Appeals Agent $18.50/ Hourly Onsite- Hamilton, NJ Full-time and Full Benefits **Location ... Summary** An experienced healthcare (Medicaid & CHIP) call-center based customer service representative to process requests for an appeal (Fair Hearings for Plan A… more
- Guardian Life (Bethlehem, PA)
- Guardian is seeking individuals with Group Disability claims experience to join our dynamic Appeals Team. The ** Appeals Case Manager II** (ACM 2) is responsible ... for adjudicating assigned appeals for Group Life and Disability claims. The ACM...+ Complimentary 1:1 financial guidance with a licensed Fidelity representative **Time Off and Remote Work** + Flexible work… more
- Guardian Life (Bethlehem, PA)
- The ** Appeals & Litigation Support Specialist** will provide comprehensive assistance to the Group Claims Disability Appeals , Litigation and Complaints team. ... levels of supervision. You will + Monitor and triage appeals queues and assign work within established guidelines. +...+ Complimentary 1:1 financial guidance with a licensed Fidelity representative **Time Off and Remote Work** + Flexible work… more
- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, October 7, 2024 Centers Plan for Healthy Living's goal is to ... Reviewer will handle expedited and standard requests and ensures that the appeals are processed in accordance with regulations, compliance standards and policy and… more
- HANAC, Inc. (Astoria, NY)
- …integral part of a team with the immigration attorney, Board of Immigration Appeals (BIA) accredited representative , and support staff. The Immigration Paralegal ... will assist the staff attorney and the Program Director in providing legal services, education, and outreach, including coordination of community events, and working under attorney supervision to assist clients on Immigration law matters. The Paralegal will… more
- Veterans Benefits Administration (Huntington, WV)
- Summary The Supervisory Veterans Service Representative - Assistant Veterans Service Center Manager (AVSCM) shares in the responsibility of managing Veterans Service ... as taking claims and assisting claimants in the preparation of claims, appeals or other documents. Delegates authority to make decisions including determining basic… more
- Randstad US (Palm Beach Gardens, FL)
- accredited veterans affairs (va) representative . + palm beach gardens , florida (remote) + posted 5 days ago **job details** summary + $65,000 - $75,000 per year + ... Job Summary: We are seeking a detail-oriented and compassionate Accredited VA Representative to assist veterans and their families in navigating VA benefits, claims,… more
- City and County of San Francisco (San Francisco, CA)
- Reporting to the Director of Construction Services, the Housing Construction Representative functions as a construction Representative for the Multifamily ... Construction Services, the primary duties of the Housing Construction Representative are: + Review architectural plans and designs and...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… more
- TAD PGS, Inc. (Chicago, IL)
- …employee grievance and disciplinary matters . + Oversees matters related to the Employee Appeals Board and acts as representative of the Employee Appeals ... Board. + Counsels various departments and offices in labor relations and employment matters such as discipline, layoffs, terminations, transfers, and numerous other matters that may arise between management and employees/unions. + Provides advice and counsel… more
- Carle (Urbana, IL)
- Revenue Cycle Denials Receivable Representative + Department: Revenue Cycle - CFH_10_19 + Entity: Champaign-Urbana Service Area + Job Category: Clerical/Admin + ... Apply Now Position Summary: Proficient in Revenue Cycle Denials Receivable Representative 1. Responsible for handling escalated account and payer issues. Handles… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Account Representative position is responsible for resolving all outstanding third party primary and secondary insurance claims for ... billing functions, including claims resubmission to payors. + Creates and submits appeals when necessary. Engages the coding follow-up team for any medical necessity… more
- State of Colorado (Adams County, CO)
- …Assistant III / Lead Customer Service Representative (Denver, CO) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4705131) Apply ... CPW Administrative Assistant III / Lead Customer Service Representative (Denver, CO) Salary $49,848.00 - $59,820.00 Annually Location Adams County, CO Job Type Full… more
- Guidehouse (Lewisville, TX)
- **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:** None Join Guidehouse on **Thursday, February 15** for ... you onboard. Join our team as a **Patient Account Representative with expected start dates in February, March, and...Skills . Experience needed for insurance focused opportunities: + Appeals & Denials + Medicare/Medicaid + Commercial & Federal… more
- Guidehouse (Birmingham, AL)
- **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** The Central Denials ... Account Representative conducts thorough account reviews to determine the appropriate...resolve claim denials and account balances. + Performing Non-Clinical Appeals . + Assisting Supervisor/Manager as needed with various projects.… more
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