- Corewell Health (Grand Rapids, MI)
- …steps of the member appeal and fair hearing processes for all non- Medicare products to thoroughly investigate appeal requests, leveraging critical thinking skills, ... Essential Functions + Responsible for complex and thorough investigation of appeals , external complaints, and fair hearing reviews including: formulate action plan… more
- Molina Healthcare (Sterling Heights, MI)
- …and contractual guidelines. + Partner with provider relations, Health plans and appeals teams to address recurring dispute trends and recommend systemic solutions. + ... improvement. **Skills & Competencies** + Proven experience handling provider disputes, appeals , and overpayment recoveries in a managed care or payer environment.… more