- Point32Health (MA)
- …Point32Health (https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
- AmeriHealth Caritas (Philadelphia, PA)
- …of medical management authorizations.; + Research and Investigate member and/or provider appeals and grievance requests, including review of UM/claim denial ... system and documents, all correspondence with a member/participant, representative and/or a provider, related to an appeal or...Care environment + 1 to 3 years' experience in grievance / appeals environment required **The Ideal Person will… more
- LA Care Health Plan (Los Angeles, CA)
- …Required: At least 5 years of experience resolving health care eligibility, access, grievance and appeals issues, preferably in health services, legal services ... Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, US,… more
- HonorHealth (AZ)
- …for appeal is clearly presented. Prioritizes and organizes own work to meet appeals and grievance deadlines. Responsible for the denials process, including ... medical records documentation and billing statements on patient accounts; submits appeals to payers on patient account denials when appropriate; reviews medical… more
- Fallon Health (Worcester, MA)
- …us on Facebook, Twitter and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance ... standards, other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH… more
- Independent Health (Buffalo, NY)
- …ICD-9-CM, ICD-10-CM and HCPCS coding preferred. + Experience in compliance regulations, appeals and grievance knowledge preferred. + Ability to effectively ... and 5pm** **Monday through Friday** . **Overview** The Provider Relations Representative will be responsible for assisting our provider constituents and providing… more
- MTA (New York, NY)
- Senior Labor Relations Representative Job ID: 12716 Business Unit: MTA Headquarters Location: New York, NY, United States Regular/Temporary: Regular Department: ... Date Posted: Aug 15, 2025 Description JOB TITLE: Senior Labor Relations Representative DEPT/DIV: Labor Relations WORK LOCATION: 420 Lexington Ave FULL/PART-TIME FUL… more
- CVS Health (Hartford, CT)
- …Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. Educates ... do it all with heart, each and every day. **Position Summary** Customer Service Representative is the face of Aetna and impacts members' service experi‐ ence by… more
- CVS Health (Columbus, OH)
- …-Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. -Educates ... EST Time Zone. Responsibilities below include, but not limited to: -Customer Service Representative is the face of Aetna and impacts members' service experience by… more
- CVS Health (Austin, TX)
- …-Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. -Educates ... we do it all with heart, each and every day. **Description** -Customer Service Representative is the face of Aetna and impacts members' service experience by manner… more