- AmeriHealth Caritas (Philadelphia, PA)
- …more about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances , this position is responsible for the ... complaints/issues to management + Monitors to ensure that all problems with appeals / grievances presented by plan members/participants are resolved in accordance… more
- Highmark Health (Harrisburg, PA)
- …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
- Community Legal Services, Inc. (Philadelphia, PA)
- …researching relevant rules, and applying them to cases + Filing administrative appeals and engaging in administrative advocacy under the supervision of an attorney ... + Representing clients (with attorneys) at administrative hearings or informal grievances with Medicaid Managed Care Organizations as needed + Presenting community… more