- Humana (Richmond, VA)
- **Become a part of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by ... trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced… more
- Evolent (Richmond, VA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator** **,** ** Appeals and Grievances ** at Evolent will serve as a point of contact ... for processing post determination reviews and appeals requests in accordance with departmental policies, regulatory requirements,...A high school diploma or GED is required. + 3 years of experience in an Intake Coordinator role… more
- Cognizant (Richmond, VA)
- …any qualified applicant in the United States. **Job Summary:** We are seeking a dedicated Appeals & Grievance Specialist with 2 to 3 years of experience to join ... processes to improve efficiency and patient satisfaction. **Responsibilities:** Reviewing available Appeals & Grievances for the pending claims to verify… more
- Somatus (Mclean, VA)
- …the Regulatory and Accreditation Team to ensure compliance with audits, complaints/ grievances , and adherence to contractual obligations and Service Level Agreements ... client pre-delegation audits, annual client audits, development of grievance and appeals workflow processes, and other regulatory requirements. + Direct, implement,… more
- Insight Global (Norfolk, VA)
- …include Claims, Encounters, Benefits Configuration, Claims & Pricing Configuration, Enrollment, Appeals & Grievances , and Contact Center/Customer Service. * ... a global third-party vendor contract specific to testing * 3 years with QNXT or FACETS **CANDIDATES MUST RESIDE...BELOW STATES TO WORK REMOTELY** 1. Alabama 2. Delaware 3 . Florida 4. Georgia 5. Idaho 6. Indiana 7.… more