- Humana (Springfield, IL)
- **Become a part of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by ... trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced… more
- Evolent (Springfield, IL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator** **,** ** Appeals and Grievances ** at Evolent will serve as a point of contact ... for processing post determination reviews and appeals requests in accordance with departmental policies, regulatory requirements,...A high school diploma or GED is required. + 3 years of experience in an Intake Coordinator role… more
- Cognizant (Springfield, IL)
- …any qualified applicant in the United States. **Job Summary:** We are seeking a dedicated Appeals & Grievance Specialist with 2 to 3 years of experience to join ... processes to improve efficiency and patient satisfaction. **Responsibilities:** Reviewing available Appeals & Grievances for the pending claims to verify… more
- Humana (Springfield, IL)
- …Utilization Manager, and Medical Director) and departments to address and resolve member grievances and appeals . + Oversees the interface with the Enrollment ... referrals, self-referral services, preventive and enhanced services, and member grievances and appeals procedures + In close...+ Prior experience with LTSS or program population. + 3 + years of leadership and management experience with direct… more
- CVS Health (Springfield, IL)
- …issue provider CAP + Monitor Grievances according NCQA standards categories ( 3 grievances per QTR), including progressive corrective action. + Monitor ... Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards * Excellent analytical… more