• Manager , Appeals…

    Molina Healthcare (Sioux City, IA)
    …* 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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  • Senior Project Manager , Claims Operations

    Molina Healthcare (Iowa City, IA)
    …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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  • Medical Director (NV)

    Molina Healthcare (Des Moines, IA)
    …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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  • LTSS Service Coordinator-Western Iowa

    Elevance Health (Adel, IA)
    …Services, Law Enforcement). + Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. + Travels to worksite and other ... 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 (10/22/25)
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