- University of Michigan (Ann Arbor, MI)
- Utilization Rev Appeals Spec Apply Now **Job Summary** **Why Join Michigan Medicine's Hospital Billing Audits & Appeals (HBAA) Department?** The Audit and ... knowledgeable about insurance requirements and medical billing practices. The Appeals Specialist will collaborate with multiple departments to maintain compliance… more
- CVS Health (Springfield, IL)
- …heart, each and every day. **Position Summary** The Manager Pharmacist, Pharmacy Appeals must have expertise and knowledge of the Pharmacy claims appeal process, ... managing the Department of Insurance (DOI) team, reviewing and resolving MAC appeals , developing and implementing solutions individually, and being a lead working… more
- State of Colorado (Denver, CO)
- Director of the Industrial Claims & Appeals Office Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5109103) Apply Director of the Industrial ... Claims & Appeals Office Salary $105,720.00 - $144,528.00 Annually Location Denver,...Department Department of Labor and Employment Division Industrial Claim Appeals Office Opening Date 10/16/2025 Closing Date 10/27/2025 5:00… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate implementation of the clinical appeal process for members ... Directs the activities and serves as a resource for associates within the Appeals and Grievances Department for Government Programs. We are looking for an… more
- Elevance Health (Woodbridge, NJ)
- **Manager II Grievance/ Appeals ** **- Claims Support** **Office Locations:** _The selected candidate must reside within a reasonable commuting distance of the ... accommodation is granted as required by law._ The **Manager II Grievance & Appeals ** responsible for management oversight of grievances and appeals departmental… more
- 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
- Sanford Health (Sioux Falls, SD)
- …oversight and operational management of the organization's member and provider appeals , complaints, and grievance processes across all product lines, including ACA, ... ensures adherence to all state, federal, CMS, HHS, and quality regulations governing appeals and grievance resolution. Lead and manage the end-to-end appeals and… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Customer Solution Center Appeals and Grievances (Temporary) Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los ... to achieve that purpose. Job Summary The Supervisor, Customer Solution Center Appeals and Grievances is responsible for direct supervision and support of the… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is...(Clinical) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals … more
- Evolent (Montpelier, VT)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a meaningful impact as part of ... a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and… more
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