- Elevance Health (Miami, FL)
- **Title: Grievance / Appeals Analyst I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... an accommodation is granted as required by law._ The ** Grievance / Appeals Analyst I** is an entry level...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Molina Healthcare (Jacksonville, FL)
- …years' experience in healthcare claims review and/or Provider appeals and grievance processing/resolution, including 2 years in a manager role. * Experience ... and DRG/RCC pricing), and IPA. + 2 years supervisory/management experience with appeals / grievance and/or claims processing within a managed care setting.… more
- Molina Healthcare (Miami, FL)
- …procedures regarding compliance with local, state and federal guidelines. * Establishes member grievance appeals and policies and updates annually or as directed ... for Medicare and Medicaid Services. * Establishes non-contracted provider dispute and appeals policies and policies and updates annually or as directed by the… more
- Elevance Health (Miami, FL)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more