- Humana (Trenton, NJ)
- …Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse ... scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the… more
- Conduent (Hamilton, NJ)
- …reports to the Appeals Supervisor and the Appeals Manager. The Appeals Manager reports to the Director of the Conduent New Jersey Eligibility project. ... individuality is noticed and valued every day. Fair Hearing Appeals Agent $18.50/ Hourly Onsite- Hamilton, NJ Full-time and...for an appeal (Fair Hearings for Plan A and Grievances for Plans B, C, and D) in a… more
- Highmark Health (Trenton, NJ)
- …medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances , and other reviews as assigned. Compose clear ... current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and… more