- Hawaiian Electric (Honolulu, HI)
- …on all aspects of litigation matters from case inception to judgment and appeals . SENIOR ASSOCIATE GENERAL COUNSEL (LITIGATION & REGULATORY) JOB FUNCTION: ... Associate General Counsel or Senior Associate ...property damage claims, from case inception to judgment and appeals ; advising officers, managers and employees regarding proposed legislation,… more
- Molina Healthcare (Kenosha, WI)
- …for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member complaints and ... **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of the Appeals & Grievances unit that is responsible for reviewing and resolving… more
- Centene Corporation (Raleigh, NC)
- …all policies and standards. **Education/Experience:** High school diploma or equivalent. Associate 's degree preferred. 2+ years grievance or appeals , claims, ... Must Reside in North Carolina **2+ years of healthcare grievance or appeals , claims, managed care experience, or relevant experience.** **Position Purpose:** Analyze… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting… more
- McLaren Health Care (Mount Clemens, MI)
- …. Provides support to both internal and external customers for denial/ appeals activities and audits. Assists with monitoring and auditing activities, reviews ... of the role to support the clinical team. 3. Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and achieve optimal payment for… more
- Beth Israel Lahey Health (Charlestown, MA)
- …a high-profile team tasked with handling all commercial and government clinical appeals and audit processes. The Clinical Analyst will perform high-level clinical ... and procedures; to gather information that would support submitted charges. Prepare clinical appeals relevant to the audits in order to prove medical necessity and… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Appeals Representative 4 - IRT (Internal Review Team) Investigates and resolves member and ... documentation to determine if an appeal or further request is warranted. The Appeals Representative 4 IRT (Internal Review Team) + Review documents + Building cases… more
- CenterWell (Helena, MT)
- …our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties that require… more
- Nuvance Health (Danbury, CT)
- …Provides high quality administrative support to Clinical Denial Prevention & Appeals Specialist RNs, Physician Advisors (PAs) and other stakeholders in ensuring ... role is instrumental in liaising with all above parties to submit provider appeals to insurance companies including Medicare and Medicaid for the Nuvance Health… more
- City of New York (New York, NY)
- …enthusiastic Trial Preparation Assistant, Level II (TPA II) to assist Appeals Bureau Assistant District Attorneys with post-conviction matters. JOB RESPONSIBILITIES: ... documents to be filed in court - Help maintain and make entries in various Appeals Bureau databases - Perform all other duties as assigned. PREFERRED SKILLS - High… more