- Humana (Raleigh, NC)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims. The Corporate ... diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the… more
- Robert Half Accountemps (Durham, NC)
- …team. This role is situated within the healthcare industry, specifically dealing with Medicare Advantage Member appeals from providers. The workplace is based in ... standards. Responsibilities: * Analyze and resolve confidential and sensitive appeals , grievances , and coverage/organization determinations from various… more
- BlueCross BlueShield of North Carolina (NC)
- …healthcare services provided to Plan members + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care + ... pharmacy utilization and effective resource management + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements + Reviews quality… more