- Humana (Raleigh, NC)
- **Become a part of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by ... trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced… more
- UNC Health Care (Morrisville, NC)
- …updates or changes through the Policy Advisory Committee. Review and coordinate appeals and grievances services as applicable. Participate in the coordination ... : Investigation and resolution of teammate relations: Maintain a representative caseload involving variety of complex teammate relations issues, including… more
- Highmark Health (Raleigh, NC)
- …paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as a resource for technical staff. ... + Other duties as assigned or requested. **QUALIFICATIONS:** **Minimum** + High school diploma or GED + Experience in pharmacy prescription claims processing/submission/payment. **Preferred** + Associate degree + Pharmacy technician certification certificate +… more