- Molina Healthcare (Kenosha, WI)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and… more
- Molina Healthcare (Green Bay, WI)
- …to healthcare premium. * Assist in resolution for escalated premium issues with Appeals and Grievances team members. * Guide and collaborates with enrollment ... team to resolve eligibility issues affecting premium billing. * Generate billing data using the QNXT premium billing module to be sent to print and fulfillment vendor. * Reconcile unallocated payments on a daily basis. * Resolve orphan member payments on a… more
- Molina Healthcare (Madison, WI)
- …to provide quality and cost-effective member care. This position will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with ... The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory… more