• Manager , Appeals…

    Molina Healthcare (Green Bay, WI)
    …**KNOWLEDGE/SKILLS/ABILITIES** + Manages staff responsible for the submission/resolution of member and provider inquiries, appeals and grievances for the ... requirements. + Maintains call tracking system of correspondence and outcomes for provider and member appeals / grievances ; oversees monitoring of each… more
    Molina Healthcare (10/11/25)
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  • Senior Project Manager , Claims Operations

    Molina Healthcare (Milwaukee, WI)
    …+ Deep understanding of claims lifecycle, EDI transactions, payment integrity, provider data, appeals / grievances , and audit/compliance (CMS, HIPAA, ... management with direct impact on Claims Operations (adjudication, configuration, appeals / grievances , payment integrity, provider data). **Preferred… more
    Molina Healthcare (10/19/25)
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  • Family Health Advocate - Remote

    Sharecare (Madison, WI)
    …open enrollment / new hire plan selection, claims issues, ID card issues, grievances / appeals , utilization management (UM) status, including but not limited to ... an exciting and innovative remote role newly created to provide meaningful support to members and their families through...payers or 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management… more
    Sharecare (10/14/25)
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  • Medical Director (NV)

    Molina Healthcare (Madison, WI)
    …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Determines… more
    Molina Healthcare (10/31/25)
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  • LTSS Service Coordinator

    Elevance Health (Sparta, WI)
    …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + Requires BA/BS ... **LTSS Service Coordinator (Case Manager )** **Hiring near Southwestern Wisconsin in counties:** Pepin,...clinical healthcare management and interdisciplinary team in order to provide care coordination support. + Manages non-clinical needs of… more
    Elevance Health (10/23/25)
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