Grievance / Appeals Analyst jobs
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GRIEVANCE/APPEALS ANALYST I
Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, under...
| Company | Elevance Health |
|---|---|
| Address | Lexington, KY |
| Category | Information Technology |
| Date Posted | 2 months ago See detail |
Grievance/Appeals Analyst I
Elevance Health
Lexington, KY
Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, under...
2 months ago seen See more...
- View all Elevance Health jobs - jobs in Lexington, KY
Grievance/Appeals Analyst I (California)
Elevance Health
WOODLAND HILLS, CA
Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, under...
2 months ago seen See more...
- View all Elevance Health jobs - jobs in WOODLAND HILLS, CA
Grievance and Appeal - Senior Analyst
Cvs Health
Columbus, OH
This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accele...
2 weeks ago seen See more...
- View all Cvs Health jobs - jobs in Columbus, OH
Grievances and Appeals Analyst I
Elevance Health
LAS VEGAS, NV
Reviews, analyzes and processes non-complex Grievances and Appeals in accordance with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, under...
2 months ago seen See more...
- View all Elevance Health jobs - jobs in LAS VEGAS, NV
Appeals Analyst
Natera
Remote
$75,000 - $86,000 a year
Develop, train, and deploy a process to submit and monitor appeals for assigned product. This. Establishes the patient authorized appeal process for medical necessity and experimental denials. Project manages patient authorized ap...
a week ago seen
Grievance and Appeals Intake Coordinator
Cvs Health
Columbus, OH
This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accele...
2 weeks ago seen See more...
- View all Cvs Health jobs - jobs in Columbus, OH
Grievances & Appeals Representative
Humana
Montana, United States
1 year of customer service experience Intermediate experience with Microsoft Word and Excel Strong communication skills both written and verbal Critical thinking skills Must have experience in a fast-paced, production driven envir...
3 weeks ago seen See more...
- View all Humana jobs - jobs in Montana State
Appeals & Grievances Specialist I - Onsite
Generac Power Systems
Waukesha, WI
Handles escalated calls/cases when a call is deemed beyond the scope of responsibility of the Customer Support Team or requires in-depth investigation, coordination and follow-up with the customer and/or their service provider. Wo...
2 weeks ago seen See more...
- View all Generac Power Systems jobs - jobs in Waukesha, WI
Senior Appeals Analyst
Parallon
Largo, FL
Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transporta...
3 weeks ago seen See more...
- View all Parallon jobs - jobs in Largo, FL
Grievance/Appeals Representative II
Elevance Health
Woburn, MA
Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues. Contacts customers to gather information and communicate disposition of case; documents interactions...
a month ago seen See more...
- View all Elevance Health jobs - jobs in Woburn, MA
Manager II Grievance/Appeals (RN)
Elevance Health
WOODLAND HILLS, CA
Description Manager II Grievance/Appeals Claims Support Location: *CA Residential Requirement This position will work a hybrid model (remote and office). This range may be modified in the future and actual compensation may var...
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- View all Elevance Health jobs - jobs in WOODLAND HILLS, CA
CBO Appeals Analyst
Mount Sinai
New York, NY
$62,571.36 - $89,843.00 a year
Monitors and reports the accuracy of contract reimbursements per payor, for both under and overpaid claims. Reviews and analyzes data in our contract compliance tool (Contract Manager), EPIC, and payor policy detail for identified...
2 months ago seen See more...
- View all Mount Sinai jobs - jobs in New York, NY
Associate VP, Grievances & Appeals, Resolution Team
Humana
Maine, United States
$164,700 - $226,600 a year
5 or more years of management experience (leading a large team within Operations environment at a large corporation) 5 or more years of healthcare/managed care industry experience Proven ability to excel in a dynamic, changing, an...
2 months ago seen See more...
- View all Humana jobs - jobs in Maine State
Grievance/Appeals Representative I
Elevance Health
Atlanta, GA
Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues. . Contacts customers to gather information and communicate disposition of case; documents interactio...
2 months ago seen See more...
- View all Elevance Health jobs - jobs in Atlanta, GA
Clinical Reviewer, Grievance & Appeals - Remote
Connecticare
New York, NY
$63,000 - $110,000 a year
Prepare and present clinical summations/recommendations to the Medical Director or Pharmacist, or Independent Review Organization in accordance with state and federal regulations, NCQA requirements, and internal policy for final c...
2 months ago seen See more...
- View all Connecticare jobs - jobs in New York, NY
Associate VP, Grievances & Appeals, Resolution Team
Humana
Delaware, United States
$164,700 - $226,600 a year
5 or more years of management experience (leading a large team within Operations environment at a large corporation) 5 or more years of healthcare/managed care industry experience Proven ability to excel in a dynamic, changing, an...
2 months ago seen See more...
- View all Humana jobs - jobs in Delaware State
Grievance & Appeals Coordinator II
Arizona Complete Health
Arizona, United States
$22.36 - $38.07 an hour
Review and process member and provider grievances and appeals within federal, state and organizational regulations and policies and procedures Review claim grievance for reconsideration and either approve/deny based on determinati...
2 months ago seen See more...
Grievance & Appeals Coordinator I
Bcforward
Ohio, United States
Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. Gather, analyze and report verbal and written member and provider complaints, grievanc...
2 months ago seen See more...
- View all Bcforward jobs - jobs in Ohio State
Grievance & Appeals Coordinator I
Bcforward
Indianapolis, IN
The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. The submission of intentionally false or fraudulent information in response to this...
2 months ago seen See more...
- View all Bcforward jobs - jobs in Indianapolis, IN
Manager I – Grievance & Appeals - Provider Disputes
Elevance Health
LAS VEGAS, NV
Monitors, trends, and analyzes grievance and appeals data for submission to appropriate parties. Serves as a clinical resource expert and mentor to unit and other departments for complex issues and interpretation of regulatory sta...
2 months ago seen See more...
- View all Elevance Health jobs - jobs in LAS VEGAS, NV
Grievance & Appeals Coordinator I
Sunshine State Health Plan
Tampa, FL
$18.66 - $31.73 an hour
Gather, analyze and report verbal and written member and provider complaints, grievances and appeals Prepare response letters for member and provider complaints, grievances and appeals Maintain files on individual appeals and grie...
2 months ago seen See more...
- View all Sunshine State Health Plan jobs - jobs in Tampa, FL
Grievances & Appeals Representative
Humana
Delaware, United States
2 years of customer service experience Strong data entry skills required Intermediate experience with Microsoft Word and Excel Must have experience in a production driven environment Must be passionate about contributing to an org...
2 months ago seen See more...
- View all Humana jobs - jobs in Delaware State
Grievances & Appeals Representative
Humana
Arkansas, United States
2 years of customer service experience Strong data entry skills required Intermediate experience with Microsoft Word and Excel Must have experience in a production driven environment Must be passionate about contributing to an org...
2 months ago seen See more...
- View all Humana jobs - jobs in Arkansas State
Appeals Processing Analyst (Payment Analysis) - Remote - Nationwide
Vituity
Sacramento, CA
Assess training opportunities and provide training to team. Create and analyze reports. Conduct payer or practice line analysis. Support team with Q&A. Ensures team procedures are current. Support supervisor with daily workflow or...
a month ago seen See more...
- View all Vituity jobs - jobs in Sacramento, CA
Appeals & Grievance (A&G) Registered Nurse (RN)
Ust
United States
$51,000 - $77,000 a year
Investigate and process complex grievances and appeals requests from members and providers. Perform reviews of inpatient, outpatient, ambulatory and ancillary services for medical necessity. Review, research, and prepare documenta...
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REMOTE | Coordinator Appeals & Grievances
Amerihealth Caritas
Dublin, OH
$35.9K - $45.5K a year
Research and Investigate member and/or provider appeals and grievance requests, including review of UM/claim denial reasons, contract/regulatory rules, benefits, and documentation received on appeal/grievance. Outreach call(s) mad...
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- View all Amerihealth Caritas jobs - jobs in Dublin, OH
Appeals & Grievance Auditor
Provider Partners Health Plan
Remote
$55.6K - $70.5K a year
Primary responsibility to perform audits of required % of A&G determinations, and letter output of those determinations. Apply policies and procedures to confirm that Appeals and Grievances meet the criteria for turnaround and/or...
2 months ago seen See more...
- View all Provider Partners Health Plan jobs
Projects Analyst - Grievance Committee (Part-time Contract)
International Monetary Fund
United States
Ability and willingness to learn and navigate new technology . Proficiency in case files, legal data management, organization, and visualization . Ability to build relationships by listening to, understanding, and addressing the n...
2 months ago seen See more...
- View all International Monetary Fund jobs
Appeals & Grievances Coordinator - Remote in NM
Unitedhealthcare
Albuquerque, NM
$50.4K - $63.9K a year
Analyze/research/understand how a service/procedure/authorization was processed and why it was denied/modified. Obtain relevant medical records to submit appeals or grievance for additional review, as needed. Leverage appropriate...
2 months ago seen See more...
- View all Unitedhealthcare jobs - jobs in Albuquerque, NM
Grievance and Appeals Nurse Specialist
Partnership Healthplan Of California
Eureka, CA
Assesses all cases to determine if members have any emergent or immediatemedical needs. Identifies potential quality of care, fraud, waste, and abuse issues.Takes appropriate actions. Executes independent clinical judgement in ass...
2 months ago seen See more...
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