- Elevance Health (Cincinnati, OH)
- **Manager II Grievance / Appeals ** **- Claims Support** **Office Locations:** _The selected candidate must reside within a reasonable commuting distance of the ... an accommodation is granted as required by law._ The **Manager II Grievance / Appeals ** responsible for management oversight of grievances and appeals … more
- Molina Healthcare (Cleveland, OH)
- …Responsible for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for reviewing and resolving ... in line with state and federal regulations. Responsible for managing the Appeals and Grievance department inventories within the key performance requirements.… more
- Molina Healthcare (Akron, OH)
- …Experience** * 7 years' experience in healthcare claims review and/or Provider appeals and grievance processing/resolution, including 2 years in a manager ... 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 (Cleveland, OH)
- …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
- Humana (Columbus, OH)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees.… more
- Humana (Columbus, OH)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team for… more
- CVS Health (Columbus, OH)
- …(PO) is responsible for leading the Medicare innovation product development for the Grievance & Appeals (G&A) Department. This role contributes to the product ... vision and translates it for the product development team. They are responsible for team backlog development and prioritization, maintaining integrity of features or components, and collaborating closely with Engineering, Design, and other stakeholders. They… more
- CVS Health (Columbus, OH)
- …Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. Educates ... to incoming correspondence and internal referrals. Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Performs… more
- Humana (Columbus, OH)
- …in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational ... committees. \#physiciancareers Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of… more
- Molina Healthcare (Cleveland, OH)
- …Management + Experience working with complex, often highly technical teams + Appeals & Grievance , healthcare services, or claims background **Preferred License, ... Certification, Association** Certified Business Analysis Professional (CBAP), Certification from International Institute of Business Analysis preferred To all current Molina employees: If you are interested in applying for this position, please apply through… more
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