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Grievance/Appeal jobs

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GRIEVANCES & APPEALS REPRESENTATIVE

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...

CompanyHumana
AddressMontana, United States
CategoryRetail
Date Posted 6 days ago See detail

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...

6 days ago seen See more...

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 days ago seen See more...

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 days ago seen See more...

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...

3 days ago seen See more...

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...

4 weeks ago seen See more...

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...

4 weeks ago seen See more...

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...

a month ago seen See more...

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...

a month ago seen See more...

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...

a month ago seen See more...

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...

a month ago seen See more...

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...

a month ago seen See more...

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...

a month ago seen See more...

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...

a month 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...

a month ago seen See more...

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...

a month ago seen See more...

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...

a month ago seen See more...

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...

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...

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...

Grievance & Appeals Analyst (Full-time Remote, North Carolina Based)

Alliance Health

Morrisville, NC

$25.00 - $32.50 an hour

Responsible for receiving and monitoring information related to provider quality assurance issues including but not limited to grievances, quality of care concerns, and/or appeals. Works to ensure comprehensive quality assurance i...

2 months ago seen See more...

Lead Grievance & Appeals Coordinator

La Healthcare Connections

Baton Rouge, LA

$22.36 - $38.07 an hour

Provide consultation for problem resolution for appeals staff and monitor team work output to ensure compliance with internal and NCQA standards. Identify training, process improvement and resource needs to maximize team performan...

2 months ago seen See more...

Grievance & Appeals Coordinator I

Wellcare New Jersey

New Jersey, United States

$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 gri...

2 months ago seen See more...

Grievance & Appeals Coordinator I

Arizona Complete Health

Tempe, AZ

$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...

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...

a month ago seen See more...

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...

a month ago seen See more...

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...

a month ago seen See more...

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...

a month ago seen See more...

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...

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...

Grievance and Appeals Coordinator

Delta Dental Of New Mexico

Albuquerque, NM

$46.2K - $58.5K a year

401(k). 401(k) matching. Dental insurance. Health insurance. Paid time off. Parental leave. Tuition reimbursement. Vision insurance. Work from home. Hybrid work. Office. Albuquerque, NM 87109: Relocate before starting work (Requir...

2 months ago seen See more...

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People who searched for Grievance/Appeal jobs also searched for Grievance / Appeals, Clinical Appeals Nurse, Clinical Appeals Specialist, Clinical Appeals Reviewer, Appeals Specialist, Appeals Supervisor, Supervisor Appeals, Appeals Manager, Manager Appeals, Grievance / Appeals Analyst, Appeals Assistant, Senior Appeals, Appeals Negotiator, Appeal Officer, Environmental Appeals Judge, . If you're getting few results, try a more general search term. If you're getting irrelevant result, try a more narrow and specific term.

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