• Specialist, Appeals Claims…

    Lincoln Financial (Lincoln, NE)
    …applying knowledge. You will analyze and manage a caseload of appeals claims . You will review, investigate, and make claim determinations regarding coverage, ... full, fair appeal reviews for multiple product lines. You will perform and deliver on appeals claims assignments/projects while simultaneously leveraging and… more
    Lincoln Financial (08/01/25)
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  • Claims Appeals Representative - Case…

    Covenant Health (Lubbock, TX)
    **Description** ** Claims Appeals Representative** **Works collaboratively with Case Management (CM) Leadership, Case Managers (CM), Complex Discharge Planners ... 3 or more years of experience in managed care claims / reimbursement setting or experience working in another other...401(k) Savings Plan with employer matching, health care benefits ( medical , dental, vision), life insurance , disability … more
    Covenant Health (07/17/25)
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  • Grievance & Appeals Specialist

    Robert Half Accountemps (Los Angeles, CA)
    … Review Coordinator or in a similar role * Proficient in handling Medical Claims and Medical Appeals * Experience with EMR - Electronic Medical ... steps. * Assist with research to advise management on medical claims issues and assist with developing...Medical Terminology * Proven track record in handling Appeals and Medical Grievances * Excellent coordination… more
    Robert Half Accountemps (07/20/25)
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  • Prior Authorization and Appeals Specialist

    AscellaHealth (Berwyn, PA)
    …including benefit investigation. + Knowledge of prior authorizations and claim appeals is necessary. + Knowledge of medical terminology is required. + ... manages the process of receiving, researching, and resolving prior authorizations and appeals issues with health insurance companies, including any escalated… more
    AscellaHealth (08/01/25)
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  • Customer Solution Center Appeals…

    LA Care Health Plan (Los Angeles, CA)
    …concurrent and post-service (retroactive review) medical necessity; benefit coverage appeals and reconsiderations, and complex provider claim disputes. The ... Health Care Services (DHCS), Department of Managed Health Care (DMHC), Managed Risk Medical Insurance Board (MBMIB) and National Committee for Quality Assurance… more
    LA Care Health Plan (07/08/25)
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  • Grievance & Appeals Coordinator II

    Centene Corporation (Phoenix, AZ)
    …is 100% remote.** **Position Purpose:** Analyze and resolve verbal and written claims and authorization grievance/ appeals from providers and members. Resolve all ... 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national...State inquires related to complaints, grievances and appeals . + Review and process member and provider grievances… more
    Centene Corporation (07/29/25)
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  • Appeals Specialist II, (Remote)

    CareFirst (Baltimore, MD)
    …FUNCTIONS:** + Independently researches contractual benefits, limitations & exclusions and claims to assist medical professional staff in performing the ... 5 years' experience in settings such as managed care, health care or insurance payor environment. 2 years' experience in Appeals and Grievance Management.… more
    CareFirst (07/30/25)
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  • IRE Grievance & Appeals Mgr II

    Elevance Health (Durham, NC)
    **Manager II Grievance/ Appeals ** **- Claims Support** **Office Locations:** _The selected candidate must reside within a reasonable commuting distance of the ... an accommodation is granted as required by law._ The **Manager II Grievance/ Appeals ** responsible for management oversight of grievances and appeals departmental… more
    Elevance Health (07/15/25)
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  • Appeals & Grievances Analyst

    Point32Health (Watertown, MA)
    …and Federal regulatory requirements + Manage the collection of documents and records ( medical , claims , administrative) needed to fully research the appeal or ... service or member services representative in health care or insurance + Preferred: 2 years' Appeals and...and comprehensive total rewards package which currently includes: + Medical , dental and vision coverage + Retirement plans +… more
    Point32Health (07/22/25)
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  • Assistant General Counsel III - Appeals…

    MTA (Brooklyn, NY)
    Assistant General Counsel III - Appeals , Torts Job ID: 12066 Business Unit: New York City Transit Location: Brooklyn, NY, United States Regular/Temporary: Regular ... Posted: Jul 10, 2025 Description Job Information Assistant General Counsel III - Appeals , Torts First Date of Posting: 7/10/2025 Last Date of Filing: Until Filled… more
    MTA (07/11/25)
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