Senior Specialist, Appeals - United States

Description · JOB DESCRIPTION Job Summary · Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established ...

Description · JOB DESCRIPTION Job Summary · Provides entry level support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements ...

+Provides lead level support for claims activities including reviewing and resolving member and provider complaints. · ...

JOB DESCRIPTION Job Summary · Provides senior level support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established ...

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth. · Clever Care was created to meet the unique needs of the diverse comm ...

The Grievance and Appeals Nurse Specialist manages medical appeals and state hearing reviews across all lines of business, · handling both expedited and standard requests.This role ensures compliance with regulations,policies,and procedures while preparing case narratives and pos ...

The Appeals & Grievances Resolution Specialist supports the intake, · investigation, and resolution of member grievances, · appeals, provider disputes, and complaints in accordance with CMS · regulations. · Ensure cases are processed within required turnaround times accurately tr ...

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. · ...

The Team You'll Join: We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. · ...

· Company Description · Healthcare Talent is assisting our client in hiring a Grievance & Appeals Nurse Specialist. The ideal candidate will manage the department work activities to ensure that service standards are met, and operations are consistent with the health plan policie ...

The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider complaints and appeals exercising strong independent judgment. This position reviews pre-service authorizations, concurrent and post-service medical n ...

Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth. · Who Are We? · Clever Care was created to meet the unique needs of t ...

The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider complaints and appeals exercising strong independent judgment. · Identifies, investigates, and resolves administrative complaints; · Intakes, acknowle ...

Description · Are you ready to make a lasting impact and transform the healthcare space? We are one of Southern California's fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.    · Who Are We?   · Clever Care was created to meet the ...

Lensa is a career site that helps job seekers find great jobs in the US. We are not a staffing firm or agency. Lensa does not hire directly for these jobs, but promotes jobs on LinkedIn on behalf of its direct clients, recruitment ad agencies, and marketing partners. Lensa partne ...

Description · Job Description · Job Summary · Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. C ...

+Job Summary · Cargomatic is seeking a highly motivated Corporate Communications Specialist to join our team. · +Responsibilities · Communications Strategy and Execution · Draft, edit and distribute original content for both internal and external communications (press releases, n ...

Description · Job Description · Job Summary · Provides support through the investigation and resolution of disputes related to provider appeals, ensuring that claims adhere to correct billing standards and regulations.  · Job Duties · Reviews coding-related provider claims denial ...

Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. · ...

+Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. · ...