- Molina Healthcare (WI)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance… more
- Molina Healthcare (Green Bay, WI)
- **JOB DESCRIPTION** **Job Summary** Responsible for reviewing and resolving Medicare member appeals and Medicare claims in communicating resolution to members and ... provider (or authorized representatives) in accordance with the standards...Responsible for the comprehensive research and resolution of the appeals from Molina members, providers and related outside agencies… more
- Cognizant (Madison, WI)
- …or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances , precertification, initial and concurrent reviews . ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more