- Centene Corporation (Sacramento, CA)
- …Hills or Natomas offices **Position Purpose:** Ensure appropriate processing of member grievance appeals , provider appeals , or request for a State Fair Hearing. ... with the State. Manage the day to day responsibilities of the Grievance & Appeals Coordinators. + Ensure that the Grievance and Appeals department processes all… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... the safety net required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the daily… more
- Evolent (Sacramento, CA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
- Robert Half Accountemps (Ontario, CA)
- Description We are looking for a detail-oriented Clinical Appeals Reviewer to join our team in Ontario, California. In this role, you will be responsible for ... coordinating and managing documentation related to clinical appeals , ensuring compliance with health plan timelines. This is...offering an excellent opportunity to contribute to the health insurance industry. 90% remote. May require the odd trip… more
- Cognizant (Sacramento, CA)
- …. Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes. ... Medicare, Medicaid, and third-party guidelines. . Effectively document and log claims/ appeals information on relevant tracking systems . Utilize critical thinking… more
- CenterWell (Sacramento, CA)
- …our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties that require… more
- Lincoln Financial (Sacramento, CA)
- …for this opportunity. **Requisition #:** 74565 **The Role at a Glance** As an Appeals Specialist you will be responsible for being a product subject matter expert to ... for multiple product lines. You will perform and deliver on appeals claims assignments/projects while simultaneously leveraging and applying knowledge. You will… more
- Emanate Health (Covina, CA)
- …from patient access (authorization, admissions) through Patient Financial Services (billing, insurance appeals , collections) procedure and policies. Ability to ... communicate in a clear and professional manner, and must have good oral and written skills. Must have high time management and organizational skills, problem solving skills. Proficient in Microsoft word, excel, outlook and similar programs. c. Minimum License… more
- Evolent (Sacramento, CA)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Appeals and Grievances** at Evolent is responsible for reviewing and processing case ... rather than phone and fax activities. **Collaboration Opportunities** : The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as… more
- Elevance Health (Costa Mesa, CA)
- **Behavioral Health Medical Director-Psychiatrist Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required ... Saturday rotation, once a month.** The **Behavioral Health Medical Director-Psychiatrist Appeals ** is responsible for the administration of behavioral health medical… more