- Swedish Health Services (Seattle, WA)
- …Re-submit claims to government agencies, medical service bureaus, and insurance companies. Submit claims appeals with supporting documentation as ... **Description** Follow up on insurance denials and aged claims , submit...we must empower them. **Required Qualifications:** + 2 years medical (or healthcare) insurance follow up experience.… more
- AmeriHealth Caritas (Philadelphia, PA)
- …of member and/or provider appeals , the analysis of claims and appeals , and the review of medical management authorizations.; + Research and Investigate ... counterparts as needed to ensure proper handling of the appeal eg UM team, medical directors, claims , contact center, vendors as needed (eg PerformRX) + Creates… more
- Covenant Health Inc. (Knoxville, TN)
- Overview Insurance Appeals Senior , Revenue Integrity and Utilization Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is ... integrity auditor to take appropriate action. Prepares necessary documentation for insurance appeals process, ensuring timely follow through. Processes claim… more
- Mount Sinai Health System (New York, NY)
- …(Industry-Specific)** : + Healthcare: Experience with utilization management for medical services, procedures, or medications + Insurance : Understanding ... **Job Description** **Director Pre Appeals Management-HSO Appeals Management -Corporate 42nd...management program. This role ensures the appropriate use of medical resources, compliance with regulatory standards, and coordination of… more
- Point32Health (FL)
- …and Federal regulatory requirements + Manage the collection of documents and records ( medical , claims , administrative) needed to fully research the appeal or ... service or member services representative in health care or insurance + Preferred: 2 years' Appeals and...and comprehensive total rewards package which currently includes: + Medical , dental and vision coverage + Retirement plans +… more
- Elevance Health (Cerritos, CA)
- …to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize and route to ... analyst may serve as a liaison between grievances & appeals and /or medical management, legal, and/or...Minimum of 3 years experience working in grievances and appeals , claims , or customer service; or any… more
- LA Care Health Plan (Los Angeles, CA)
- …Health Care Services (DHCS), Department of Managed Health Care (DMHC), Managed Risk Medical Insurance Board (MBMIB) and National Committee for Quality Assurance ... position reviews pre-service authorizations, concurrent and post-service (retroactive review) medical necessity; benefit coverage appeals and reconsiderations,… more
- MTA (Brooklyn, NY)
- Assistant General Counsel III - Appeals , Torts Job ID: 12066 Business Unit: New York City Transit Location: Brooklyn, NY, United States Regular/Temporary: Regular ... Posted: Jul 10, 2025 Description Job Information Assistant General Counsel III - Appeals , Torts First Date of Posting: 7/10/2025 Last Date of Filing: Until Filled… more
- Molina Healthcare (Salt Lake City, UT)
- …to reduce the likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by applying advanced clinical ... in the specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific… more
- Point32Health (Canton, MA)
- …and Federal regulatory requirements + Manage the collection of documents and records ( medical , claims , administrative) needed to fully research the appeal or ... **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals ...and comprehensive total rewards package which currently includes: + Medical , dental and vision coverage + Retirement plans +… more
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