- Elevance Health (Cerritos, CA)
- Title: Grievance / Appeals Analyst I Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... required by law. * Shift hours: Tuesday - Saturday 8:30am - 5:00pm EST The Grievance / Appeals Analyst I is an entry level position in the Enterprise Grievance … more
- Humana (Raleigh, NC)
- …call center or related customer service experience. 2 - 4 years of grievance and/or appeals experience. Previous experience processing medical claims. Additional ... expertise truly makes an impact! As a Grievances & Appeals Representative, you'll be a go-to problem solver, turning...and determine the best course of action-whether that's a grievance , appeal, or next steps. You'll own the process… more
- Cognizant (Denver, CO)
- …applicant that lives in the United States. Summary: We are seeking a dedicated Provider Appeals & Grievance Specialist with1 to 2 years of experience to join our ... Management and state Medicaid policies. Basic qualifications: 2 years of Appeals and Grievance 1 Year of medical claims processing experience (Must be with… more
- Sanford Health (Sioux Falls, SD)
- …strategic oversight and operational management of the organization's member and provider appeals , complaints, and grievance processes across all product lines, ... adherence to all state, federal, CMS, HHS, and quality regulations governing appeals and grievance resolution. Lead and manage the end-to-end appeals and… more
- Molina Healthcare (Sterling Heights, MI)
- …claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. Requests and reviews medical records, notes, ... month Essential Job Duties Facilitates comprehensive research and resolution of appeals , disputes, grievances, and/or complaints from Molina members, providers, and… more
- Humana (Austin, TX)
- …roles include an overview of coding practices and clinical documentation, dispute, grievance , and appeals processes, and outpatient services and equipment, ... member population, or condition type. May also engage in dispute, grievance , and appeals reviews. May participate on project teams or organizational committees.… more
- CVS Health (Indianapolis, IN)
- …Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. Educates ... to incoming correspondence and internal referrals. Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Performs… more
- CVS Health (Trenton, NJ)
- …obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals , SIU, etc. Coordinates provider status information ... Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards Excellent analytical and… more
- UTMB Health (Galveston, TX)
- …action. Provides advice and guidance to managers regarding the employee grievance and appeals processes. Administers, interprets, communicates, and leads ... training regarding various human resources policies, procedures, federal and state employment laws, and initiatives that impact the work environment to management and employees. Serves as the employee relations expert to HR Business Partners and other HR… more
- Robert Half (Eden Prairie, MN)
- Description Clinical Appeals Representative (Contract - Fully Remote) We're seeking a detail-oriented Clinical Appeals Representative to join our team on a ... health insurance operations by managing documentation, coordinating with providers, and ensuring appeals and grievances are processed accurately and on time. This is… more
- Molina Healthcare (Caldwell, ID)
- …Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and ... to ensure that internal and/or regulatory timelines are met. Research claims appeals and grievances using support systems to determine appeal and grievance… more
- Transdev (Readville, MA)
- …Research, compile, and prepare data for use in grievance hearings, arbitration proceedings, labor/management initiatives, collective bargaining negotiations, ... Human Resources policies and governmental laws and regulations. Manage the grievance process and provide comprehensive responses to complaints, grievances, and… more
- Elevance Health (Mason, OH)
- **Manager II Grievance / Appeals -RN** **Location** : Ohio-Cincinnati, Columbus, Mason, or Seven Hills ( _Must be within commutable distance to one of the listed ... an accommodation is granted as required by law._ The **Manager II Grievance / Appeals ** is responsible for management oversight of grievances and appeals … more
- Centene Corporation (Harrisburg, PA)
- …member and provider complaints, grievances and appeals + Maintain files on individual appeals and grievances + May coordinate the Grievance and Appeals ... High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals , claims, related managed care experience, or… more
- Elevance Health (Mason, OH)
- …by medical directors and consultants; preparing recommendations to uphold or deny appeals ; and ensuring all grievance processes are completed within regulatory ... legal proceedings, and/or paralegal experience is strongly desired. .Understanding of the grievance and appeals process is strongly preferred. .Basic knowledge… more
- CVS Health (Columbus, OH)
- …compassionate. And we do it all with heart, each and every day. **Position Summary** Enter grievance and appeals cases into the G&A system to launch the case for ... - Working knowledge of problem solving and decision making skills. - Grievance and appeals experience. **Preferred Qualifications** Health Insurance Call Center… more
- Point32Health (FL)
- …Point32Health (https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
- CVS Health (Hartford, CT)
- …AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. * Health Plan Experience Highly ... of this Medical Director role are related to Medicare Appeals :** * Direct daily work on part C ...Appeals :** * Direct daily work on part C appeals (both provider and member/nonparticipating providers). * Provide direct… more
- LA Care Health Plan (Los Angeles, CA)
- …the Clinical Programs. + Develop and execute on strategic opportunities to improve the overall appeals & grievance process. Create a best in clinical appeals ... experience with at least 3 years of experience with health care grievance and/or appeals issues, preferably in a managed care or Medicaid Health Plan environment… more
- Humana (Richmond, VA)
- …center or related customer service experience. + 2 - 4 years of grievance and/or appeals experience. + Previous experience processing medical claims. ... expertise truly makes an impact! As a Grievances & Appeals Representative, you'll be a go-to problem solver, turning...and determine the best course of action-whether that's a grievance , appeal, or next steps. You'll own the process… more
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