• Lead Specialist , Appeals…

    Molina Healthcare (Milwaukee, WI)
    …Duties** * Serves as team lead for submission, intervention and resolution of appeals , grievances , and/or complaints from Molina members, providers and related ... and provides guidance to others with respect to complex appeals and grievances . * Researches and resolves...subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and… more
    Molina Healthcare (01/18/26)
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  • Appeals & Grievances…

    Molina Healthcare (Racine, WI)
    …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to...subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and… more
    Molina Healthcare (12/14/25)
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  • Associate Specialist , Appeals…

    Molina Healthcare (Kenosha, WI)
    …with research. * Determines appropriate language for letters and prepares responses to member appeals and grievances . * Elevates appropriate appeals to the ... problem-solving in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with… more
    Molina Healthcare (01/17/26)
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  • National Contracting Director (Large Hospital…

    Molina Healthcare (Kenosha, WI)
    …for claims payment); Provider/Member Inquiry Research and Resolution; and Provider/Member Appeals and Grievances . * Coordinates with Corporate and Business ... and/or regulatory requirements. * Monitors and reports network adequacy for Medicare and Medicaid services. * Develops strategies to improve EDI/MASS rates.… more
    Molina Healthcare (01/11/26)
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