- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Lead Customer Solution Center Appeals and Grievances RN is responsible for assisting with the development of a… more
- Centene Corporation (Indianapolis, IN)
- …**Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. ... and report verbal and written member and provider complaints, grievances and appeals + Prepare response letters for member and provider complaints, grievances and… more
- Elevance Health (Union, NE)
- **SCA Appeals Representative I** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... Medicare and Medicaid Services to transform federal health programs. The **SCA Appeals Rep I** is Responsible for reviewing, analyzing, and processing non-complex… more
- Molina Healthcare (WI)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are ... reviews of previously denied cases in which a formal appeals request has been made or upon request by...chief medical officer for administrative law judge pre-hearings, state insurance commission, and meet and confers. * Represents Molina… more
- Logan Health (Kalispell, MT)
- … denials processing as applicable to assigned area(s). + Responsible for all insurance appeals and works with appropriate stakeholders to ensure completion as ... and promptly. + Help patients understand billing statements, EOBs, and insurance claims. + Post payments and adjustments accurately, ensuring alignment with… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Appeals & Grievance Liaison Associate Location: Remote Career Area: Customer ... an important expansion of our job family structure within Appeals & Grievances. The position will offer visibility into...package which may include: * Medical, dental, and vision insurance * Life insurance * 401k *… more
- CareFirst (Baltimore, MD)
- …& Qualifications** **PURPOSE:** We are looking for a Director, Medical Review & Appeals for our Government Programs lines of business. The incumbent will ensure ... and oversight of the Clinical Medical Claims Reviews, Clinical Appeals and Analysis programs and Quality of Care complaints...years' experience leading in a managed care or health insurance environment with a focus on Clinical Medical Review… more
- AmeriHealth Caritas (Philadelphia, PA)
- …. **This position is hybrid in Philadelphia, PA** **Job Summary** The Appeals & Grievance Case Resolution Specialist is responsible for the full life ... cycle of assigned member and/or provider appeals and grievance cases. Working under general supervision, this...Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day… more
- CenterWell (Denver, CO)
- …data analytics, denial and appeal process. The Director, Home Health Grievances & Appeals assists members, via phone or face to face, further/support quality related ... development/implementation required + Expert knowledge of all Medicare regulations and appeals processes + Excellent analytical skills with ability to interpret and… more
- Elevance Health (FL)
- ** Appeals Medical Director - Medicare** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... is granted as required by law. Alternate locations may be considered. The ** Appeals Medical Director** is responsible for the appeal reviews for physical health… more