• Appeals Representative

    Humana (Boston, MA)
    …a part of our caring community and help us put health first** The Appeals Representative 4 Investigates and resolves member and practitioner issues. manages ... determine if an a grievance, appeal or further request is warranted. The Appeals Representative 4 + Review documents + Building cases + Inventory Management +… more
    Humana (09/10/25)
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  • Patient Account Associate II Payment Research…

    Intermountain Health (Boston, MA)
    …such as debits/credits, required + Experience with insurance claim appeals , required + Excellent computer skills (including Microsoft Office applications), ... required- Familiarity with electronic remittances, required **Physical Requirements** + Interact with others by effectively communicating, both orally and in writing + Operate computers and other office equipment requiring the ability to move fingers and hands… more
    Intermountain Health (09/05/25)
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  • Representative II, Accounts Receivable

    Cardinal Health (Boston, MA)
    …the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes ... denials & rejections for re-submission (billing) in accordance with company policy, regulations, or third-party policy. + More challenging claim cases + Investigates and updates the system with all information received from secondary insurance companies. +… more
    Cardinal Health (08/24/25)
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  • Member Intake Admin - Hybrid $22/hr

    Fallon Health (Worcester, MA)
    …on Facebook, Twitter and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance with ... standards, other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH … more
    Fallon Health (08/13/25)
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  • Pharmacy Coordinator

    Highmark Health (Boston, MA)
    …of benefit billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as ... a resource for technical staff. + Other duties as assigned or requested. **QUALIFICATIONS:** **Minimum** + High school diploma or GED + Experience in pharmacy prescription claims processing/submission/payment. **Preferred** + Associate degree + Pharmacy… more
    Highmark Health (09/09/25)
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  • Public Records Division Public Records Specialist

    State of Massachusetts (Boston, MA)
    …of Records (Supervisor), the Division processes and issues determinations on appeals from requestors denied access to government records; responds to questions ... Massachusetts Public Records Law. . Assist in opening administrative appeals pertaining to the Public Records Law; . Manage...the Commonwealth is an Equal Opportunity Employer. As a representative of the Commonwealth and its residents, the Office… more
    State of Massachusetts (08/23/25)
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  • Public Records Attorney

    State of Massachusetts (Boston, MA)
    …of Records (Supervisor), the Division processes and issues determinations on appeals from petitioners denied access to government records; responds to inquires ... Attorney General Opinions, Executive Orders and prior Supervisor Determinations; . Review appeals from public records requesters who have been denied access to… more
    State of Massachusetts (08/29/25)
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  • Supervisor Dental Government Business Operations

    Highmark Health (Boston, MA)
    …correspondence inquiries (routine, priority Congressional / Department of Defense), and appeals . Ensures that all processes are compliant with requirements and ... Provides direction for priority Congressional and Department of Defense inquiries and appeals . + Performs administration tasks such as leave approvals and functions… more
    Highmark Health (08/22/25)
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  • Billing & Certified Coding Specialist II

    Beth Israel Lahey Health (Burlington, MA)
    …in order to determine appropriate coding and initiate corrected claims and appeals . Duties include hands on coding, documentation review and other coding needs ... the Billing Supervisor with the resolution of complex claims issues, denials and appeals . 16. Completes projects and research as assigned. 17. Provides feedback and… more
    Beth Israel Lahey Health (08/08/25)
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  • Labor Relations Manager

    Transdev (Readville, MA)
    …internal policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances. + Understand legal requirements and governmental ... personnel so classified. The physical demands described here are representative of those that must be met by an...legally protected status. The physical demands described here are representative of those that must be met by an… more
    Transdev (07/03/25)
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