• Unknown (New York, NY)
    …management eligibility and enrollment services medicaid and chip administration health insurance appeals technology customer experience and digital solutions ... & Professional Services Government Specialties government program operations health insurance exchanges case management customer contact centers business process… more
    Appcast IO CPC (01/01/26)
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  • Unknown (New York, NY)
    …Enterprise Specialties aca compliance employee benefits administration aca reporting marketplace appeals aca irs efiling hcm optimization data integration and open ... of entities, including system integrators, HCM providers, benefit administrators, insurance brokers, direct-to-employer channels, and insurance carriers. Key… more
    Appcast IO CPC (01/01/26)
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  • Appeals Manager

    BronxCare Health System (Bronx, NY)
    Overview The Appeals Manager is responsible to assist in the analysis and preparation of response to denial notification letters that arrive in letter and electronic ... format. Collaborating with the Department Denial and Appeals Coordinators, Physician Advisors, and the clinical staff, the Appeal Manager is responsible to develop a… more
    BronxCare Health System (11/15/25)
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  • Director Pre Appeals Management-HSO…

    Mount Sinai Health System (New York, NY)
    **Job Description** **Director Pre Appeals Management-HSO Appeals Management -Corporate 42nd Street-Full-Time-Days -Remote** The Director, Pre Appeals ... who provides strategic leadership and operational oversight for the hospital's pre- appeals management program. This role ensures the appropriate use of medical… more
    Mount Sinai Health System (11/01/25)
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  • Appeals Nurse

    Evolent (Albany, NY)
    …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
    Evolent (12/24/25)
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  • Assistant General Counsel III - Appeals

    MTA (Brooklyn, NY)
    Assistant General Counsel III - Appeals , Torts Job ID: 12066 Business Unit: New York City Transit Location: Brooklyn, NY, United States Regular/Temporary: Regular ... Posted: Jul 10, 2025 Description Job Information Assistant General Counsel III - Appeals , Torts First Date of Posting: 7/10/2025 Last Date of Filing: Until Filled… more
    MTA (01/08/26)
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  • Director, Home Health Grievances & Appeals

    CenterWell (Albany, NY)
    …data analytics, denial and appeal process. The Director, Home Health Grievances & Appeals assists members, via phone or face to face, further/support quality related ... development/implementation required + Expert knowledge of all Medicare regulations and appeals processes + Excellent analytical skills with ability to interpret and… more
    CenterWell (01/08/26)
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  • Medical Director - Pharmacy Appeals

    Humana (Albany, NY)
    …The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately ... Medical Director's work includes computer based review of moderately complex to complex appeals for coverage for drugs using resources outlined above as well as… more
    Humana (12/03/25)
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  • Audit & Reimbursement II- Appeals

    Elevance Health (East Syracuse, NY)
    **Audit & Reimbursement II- Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... Perform cost report reopenings. + Under guided supervision, participate in completing appeals related work: + Position papers + Jurisdictional Reviews + Maintaining… more
    Elevance Health (01/08/26)
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  • Lead, Accounts Receivable Specialist

    Cardinal Health (Albany, NY)
    …maintain optimal account receivables performance and client satisfaction. + Resolves complex insurance claims, including appeals and denials, to ensure timely ... as a subject matter expert in claims processing. + Processes claims: investigates insurance claims; properly resolves by follow-up & disposition. + Lead and manage… more
    Cardinal Health (12/09/25)
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