- Evolent (Springfield, IL)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The ** Coordinator , Appeals and Grievances ** at Evolent is responsible for reviewing ... prior authorization experience. This role is distinct from other coordinator positions in that it is dedicated to case...required. + Minimum of 3 years' experience in an Appeals and Grievances role or comparable administrative… more
- CVS Health (IL)
- …Prepares information and reports needed to address matters regarding complaints, appeals , and grievances . Carries out policies, procedures, and programs ... state regulations. **What you will do** + Reviews, and processes appeals and grievances filed by patients. + Assists with adherence to regulatory requirements,… more
- Highmark Health (Springfield, IL)
- …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 technician certification… more
- Humana (Springfield, IL)
- …immediate and acute gaps in care and access. + Assists enrollees with filing grievances and appeals . + Provides information to enrollee related to MCO ... for the care and wellbeing of members. The Care Coordinator _(Care Coach 1)_ employs a variety of strategies,...skills to make an impact** **Required Qualifications** The Care Coordinator _(Care Coach 1)_ must meet **one (1)** of… more