• Director, Appeals & Grievances

    Molina Healthcare (St. Petersburg, FL)
    …apply state level requirements to meet contract and regulatory expectations. * Establishes Appeals & Grievances department policies and procedures in line with ... and interprets trends and prepares reports that identify root causes for Appeals , Grievances , and Provider Disputes. Recommends and implements process… more
    Molina Healthcare (07/20/25)
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  • Appeals & Grievances Program Advisor

    Commonwealth Care Alliance (Boston, MA)
    011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA and other related quality program activities including: monthly case quality monitoring, coordination of… more
    Commonwealth Care Alliance (05/21/25)
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  • Manager, Customer Solution Center Appeals

    LA Care Health Plan (Los Angeles, CA)
    Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, ... achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage… more
    LA Care Health Plan (07/08/25)
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  • Customer Solution Center Appeals

    LA Care Health Plan (Los Angeles, CA)
    Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, ... to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and… more
    LA Care Health Plan (07/08/25)
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  • Specialist, Appeals & Grievances

    Molina Healthcare (Omaha, NE)
    …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. +… more
    Molina Healthcare (06/26/25)
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  • Specialist, Appeals & Grievances

    Molina Healthcare (Caldwell, ID)
    …to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine Provider No Surprises ... + Min. 2 years operational managed care experience (call center, appeals or claims environment). + Health claims processing background, including coordination… more
    Molina Healthcare (08/01/25)
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  • Director, Appeals & Grievances

    Molina Healthcare (Des Moines, IA)
    …and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with the standards and requirements established by ... and directs the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes that is responsible for reviewing and resolving contracted… more
    Molina Healthcare (07/18/25)
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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 ... as well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is… more
    Commonwealth Care Alliance (05/21/25)
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  • Member Appeals and Grievance Intake Admin…

    Fallon Health (Worcester, MA)
    …of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and ... assigning all incoming appeals and grievances addressed to the Member Appeals & Grievances Department. This position will also provide administrative… more
    Fallon Health (08/01/25)
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  • Appeals Specialist II, (Remote)

    CareFirst (Baltimore, MD)
    …collecting, organizing and tracking information to facilitate and expedite processing of appeals / grievances received from a variety of sources. Responsible for ... assist medical professional staff in performing the review of more complex grievances , appeals , and reconsiderations. Prioritize, research, analyze, and perform… more
    CareFirst (07/30/25)
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