• Grievances & Appeals…

    Humana (Trenton, NJ)
    …us put health first** Become a valued member of Humana's Internal Review Team as a Grievances & Appeals Representative , where you will play a critical role ... you will perform thorough reviews of clinical documentation to assess whether grievances , appeals , or additional requests are justified, and provide final… more
    Humana (11/19/25)
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  • Appeals and Grievance Analyst

    Point32Health (NJ)
    …responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for ... + Must be able to organize, plan and implement the functions of Member Appeals and Grievances , maintain timelines and turnaround times to meet multiple… more
    Point32Health (11/14/25)
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  • Pharmacy Coordinator

    Highmark Health (Trenton, NJ)
    …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 certificate +… more
    Highmark Health (10/16/25)
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