- Molina Healthcare (San Antonio, TX)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and… more
- Molina Healthcare (Fort Worth, TX)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. +… more
- Molina Healthcare (Houston, TX)
- …with research. * Determines appropriate language for letters and prepares responses to member appeals and grievances . * Elevates appropriate appeals to the ... in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with provider and member… more
- Molina Healthcare (Houston, TX)
- …* At least 2 years of managed care experience in a call center, appeals , and/or claims environment, or equivalent combination of relevant education and experience. * ... and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and ... and resolution of cases; review, research and coordination of complaints, grievances , appeals and reconsiderations consistent with statutory and federal… more
- CVS Health (Austin, TX)
- …Integrated Product Experience + Experience with Part D Coverage Determination, Appeals and Grievances and/or Formulary Administration regulatory requirements and ... within budgeted costs. **What you will do** + Acts as a top-level specialist on project management and develops a comprehensive plan that encompasses objectives,… more
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