- Alameda Health System (Oakland, CA)
- …communication and collaboration with internal departments, external agencies, and insurance providers to facilitate the utilization review process. Participate in ... more
- Intermountain Health (Columbus, OH)
- …evidence-based utilization review criteria to assess and write up clinical reviews for insurance audits and governmental insurance appeals using supporting ... more
- CVS Health (Phoenix, AZ)
- …meetings when required. * Understands and can respond to Executive complaints and appeals , Department of Insurance , Department of Health or Attorney General ... more
- AscellaHealth (Berwyn, PA)
- …manages the process of receiving, researching, and resolving prior authorizations and appeals issues with health insurance companies, including any escalated ... more
- Equitable (Charlotte, NC)
- …Complaints, and Litigation team is responsible for managing and resolving complex insurance claims disputes. This role involves investigating appeals , preparing ... more
- Humana (Columbus, OH)
- …firm paralegal experience preferably with experience in medical or Medicare/Medicaid insurance + Experience involving the Medicare administrative appeals process ... more
- Corewell Health (Royal Oak, MI)
- …received. + Request insurance authorizations for genetic testing and perform insurance appeals for all denied testing. Follow up on authorizations approvals ... more
- Intermountain Health (Columbus, OH)
- …of accounting procedures such as debits/credits, highly preferred - Experience with insurance claim appeals , highly preferred - Excellent computer skills ... more
- VNS Health (Manhattan, NY)
- …complexities of healthcare? VNS Health Plans is seeking a dedicated Manager, Grievance and Appeals (RN)to lead the daily operations of our grievance and appeals ... more
- Fallon Health (Worcester, MA)
- …and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in ... more
- University of Michigan (Ann Arbor, MI)
- …for both the inpatient and outpatient populations. They are knowledgeable about insurance requirements and medical billing practices. The Appeals Specialist will ... more
- Point32Health (MA)
- …and communities. **Job Summary** Under the Supervisor's direction, the Member Appeals and Grievances Department Coordinator assists with all operational aspects of ... more
- AmeriHealth Caritas (Philadelphia, PA)
- …about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances, this position is responsible for the ... more
- VNS Health (Manhattan, NY)
- …including intake, classification, setup, and assignment of grievances and appeals . Additionally, provides administrative support to staff, including tasks such ... more
- Point32Health (TX)
- …colleagues and communities. **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst ... more
- Catholic Health Services (Melville, NY)
- …advisors and facility departments. | Develops/validates daily work lists for Utilization and Appeals Manager. | Assist with all insurance and regulatory audits ... more
- Elevance Health (Columbus, OH)
- **Manager II Grievance/ Appeals (RN)** **Location** : This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one ... more
- AscellaHealth (Berwyn, PA)
- …manage an active pharmacy but assist with supervising therapy adherence and health insurance appeals related to specialty therapies. This position could evolve ... more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …help us transform healthcare? Bring your true colors to blue. The RoleThe Appeals Nurse Reviewer is responsible for reviewing provider claims appeals , validating ... more
