• Coord Appeals & Grievances

    AmeriHealth Caritas (Philadelphia, PA)
    …about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances, this position is responsible for the ... administrative tasks for coordination of member and/or provider appeals , the analysis of claims and appeals ,...provider appeals , the analysis of claims and appeals , and the review of medical management authorizations.; +… more
    AmeriHealth Caritas (08/23/25)
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  • Appeals /Grievance Coordinator I - SHP…

    Sharp HealthCare (San Diego, CA)
    …Will Do** Responsible for the investigation, documentation and resolution of member appeals and grievances in compliance with State law, rules, and guidelines; ... Chief Medical Officer (CMO) who is responsible for all decisions regarding clinical appeals and grievances and the Chief Operations Officer (COO) who is responsible… more
    Sharp HealthCare (08/20/25)
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  • Appeals /Grievance Coordinator I - SHP…

    Sharp HealthCare (San Diego, CA)
    …Do** Responsible for the investigation, documentation and resolution of Commercial member appeals and grievances in compliance with State law, rules, and guidelines; ... Chief Medical Officer (CMO) who is responsible for all decisions regarding clinical appeals and grievances and the Chief Operations Officer (COO) who is responsible… more
    Sharp HealthCare (08/20/25)
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  • Appeals and Grievance Analyst

    Point32Health (MA)
    …(https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
    Point32Health (08/16/25)
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  • Prior Authorization and Appeals Specialist

    AscellaHealth (Berwyn, PA)
    What we are looking for Optime Care seeks a Prior Authorization and Appeals Specialist for our Berwyn, PA location. We are looking for someone who is passionate ... manages the process of receiving, researching, and resolving prior authorizations and appeals issues with health insurance companies, including any escalated step of… more
    AscellaHealth (08/01/25)
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  • Sr Complaints and Appeals Coordinator

    CVS Health (Sacramento, CA)
    …Summary** Responsible for Oversight of that that investigates and resolution of appeals scenarios for all products, which may contain multiple issues and, may ... responses from multiple business units. Ensure timely, customer focused response to appeals . Identify trends and emerging issues and report and recommend solutions.… more
    CVS Health (08/28/25)
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  • Clinical Denial Appeals Specialist

    TEKsystems (Annapolis, MD)
    Description Position Summary The clinical denial appeals specialist is responsible for the identification, mitigation, and prevention of clinical denials. This staff ... reviews all initial clinical denials to determine next steps and conducts appeals as appropriate, such as by reviewing medical necessity, responding to authorization… more
    TEKsystems (08/26/25)
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  • Appeals and Grievance Specialist

    Commonwealth Care Alliance (Boston, MA)
    011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances team ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
    Commonwealth Care Alliance (08/20/25)
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  • Director - Billing Operations - Appeals

    Caris Life Sciences (Irving, TX)
    …Life Sciences is seeking an experienced and strategic Director of Billing Operations - Appeals to lead the appeals management function for an assigned payor ... and genetic testing services. This role is responsible for overseeing appeals processes associated with denials from Caris-contracted and non-contracted commercial… more
    Caris Life Sciences (08/08/25)
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  • Customer Solution Center Appeals

    LA Care Health Plan (Los Angeles, CA)
    Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
    LA Care Health Plan (08/26/25)
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