• Manager , Appeals…

    Molina Healthcare (FL)
    …* Manages team responsible for the submission/resolution of member and provider appeals and grievances ; ensures resolutions are compliant with applicable ... call tracking system of correspondence and outcomes for provider and member appeals / grievances ; oversees/monitors appeals to ensure all internal and… more
    Molina Healthcare (11/13/25)
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  • Grievance/ Appeals Representative I

    Elevance Health (Miami, FL)
    …you will make an impact:** + Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues. ... of previously processed claims. + Ensures appropriate resolution to inquiries, grievances and appeals within specified timeframes established by either… more
    Elevance Health (11/07/25)
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  • Nurse Appeals RN-Quality of Care

    Elevance Health (Tampa, FL)
    **Nurse Appeals RN-Quality of Care** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while ... Work Hours:** Monday-Friday, 8:00AM -5:00 PM Eastern Standard Time The **Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
    Elevance Health (11/12/25)
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  • Senior Project Manager , Claims Operations

    Molina Healthcare (St. Petersburg, FL)
    …Design scalable workflows and controls across intake, adjudication, adjustments, appeals / grievances , and payment integrity. + Technology Enablement: Oversee ... understanding of claims lifecycle, EDI transactions, payment integrity, provider data, appeals / grievances , and audit/compliance (CMS, HIPAA, NCQA, state regs). +… more
    Molina Healthcare (10/19/25)
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  • Claims Manager

    CHS (Clearwater, FL)
    …client trust. * Investigates and participates in formal responses relating to complaints, grievances and appeals received by or applicable to PAS. Participates ... **Overview** **Claims Manager ** **Servicing** **Health Insurance Policies or Benefits** **Summary:**...stated coverage. Join Premier Administrative Solutions as a Claims Manager and lead our Claims Department in delivering exceptional… more
    CHS (11/06/25)
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  • LTSS Service Coordinator - Case Manager

    Elevance Health (Tampa, FL)
    …Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. **Minimum Requirements:** + Requires BA/BS ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
    Elevance Health (11/06/25)
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  • Senior Manager , Audit and Business…

    CVS Health (Tallahassee, FL)
    …Integrated Product Experience + Experience with Part D Coverage Determination, Appeals and Grievances and/or Formulary Administration regulatory requirements and ... audit management + Experience with Part C & D reporting requirements + 3+ years serving as project lead + Adept at problem solving and decision making + Experience dealing with state or federal regulators + Excellent written and verbal communication skills and… more
    CVS Health (11/07/25)
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  • Medical Director (NV)

    Molina Healthcare (Jacksonville, FL)
    …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse… more
    Molina Healthcare (10/31/25)
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  • Neuroscience Area Business Specialist…

    J&J Family of Companies (Jacksonville, FL)
    …eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ); REMs certification; Medicare and Medicaid rules and ... * Interviews with the team: If you move forward, you'll meet with the hiring manager (and possibly others on the team) in one or two interview rounds, depending on… more
    J&J Family of Companies (11/14/25)
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  • Pharmacy Technician I

    Elevance Health (Miami Lakes, FL)
    …relevant parties of all prior authorization determinations. + Provides resolutions to grievances and appeals issues. **Minimum Requirements:** + Requires HS ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
    Elevance Health (11/05/25)
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