Remote Appeals & Grievances Specialist
Humana
- Remote job
Humana is seeking a Grievances and Appeals Representative 4 within the Internal Review Team to manage denials by reviewing clinical documentation and coordinating with clinical and internal Humana partners to validate final determinations. You will handle Level 1 appeal cases, review documentation, and collaborate with teams to finalize outcomes, while maintaining high productivity and strict confidentiality in a remote work setup. #J-18808-Ljbffr Humana
- ...Point32Health, Inc. is seeking an Appeals and Grievance Coordinator to manage day-to-day tasks within the A&G department. You will process mail, assign cases, and support analysts while ensuring compliance with regulatory timelines. The role requires 1-2 years of relevant...Remote workWork from home
- ...Healthfirst is seeking a Grievance Specialist to join its Appeals & Grievances team in a fully remote position. You will manage and resolve member complaints across Medicare, Medicaid, and other Healthfirst programs, coordinating with internal teams and external partners...Remote work
- ...Workday is seeking a Grievance & Appeal Specialist to address appeals within required timeframes and ensure contractual obligations are met. The... ...Procedures to ensure compliance with regulatory standards. This remote position requires strong communication, confidentiality,...Remote work
$60.78k
...Appeals And Grievances Specialist II Job Category: Customer Service Department: Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position... ...work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical...Remote workFull timeLocal areaShift workWeekend work- Elevance Health in California is seeking an entry-level Analyst in the Enterprise Grievance & Appeals Department to review, analyze and process non-complex grievances and appeals across multiple product types, including HMO, PPO, POS, and others. You will work under guidance...Remote job
- A healthcare service provider is seeking an Appeals and Grievances Clinical Specialist to manage member complaints and clinical case resolutions. This is a 100% remote role requiring an RN, LPN, or Dental Hygienist license. Responsibilities include developing cases, researching...Remote work
$21.16 - $38.37 per hour
Join to apply for the Medicare Appeals & Grievances Specialist (PST Hours) role at Molina Healthcare . This position is remote and will be working Pacific Standard hours. Highly Qualified Candidates Will Have The Following Experience Strong understanding of UM, Appeals...Remote workHourly payFull timeContract workWork experience placementWork at office$26.99 per hour
We are currently seeking experienced Appeals & Grievances Specialists! This is a full remote opportunity paying $27/hr. The ideal candidate has experience investigating and responding in writing to internal and regulatory complaints. Experience in ACA is a plus. If...Remote workHourly payPermanent employmentTemporary workWork experience placementShift work- ...Member Appeals Specialist Primary responsibilities would include triaging incoming appeals/grievances, categorizing them appropriately, assigning them to the team, making outbound calls when necessary. Also checking voicemails, responding to emails/voicemails. The...Remote workTraineeship
- A Medical Claims Organizations is in the immediate need of Grievance and Appeals Specialist with experience in grievances and appeals to join the team. The Grievance and Appeals Specialist is responsible for reviewing, investigating, and resolving member and provider grievances...Immediate start
- Humana Inc. is seeking a Grievances & Appeals Representative 3 to handle expedited Medicaid and AIP (dual) appeals, reviewing clinical documentation... ...report to the Grievances & Appeals Supervisor and work in a remote setup with possible travel for training or meetings.J-18808-...Remote job
$21.16 - $38.37 per hour
A healthcare provider is seeking a Medicare Appeals & Grievances Specialist to handle member appeals and grievances. This remote position requires strong experience in managed care, particularly with Medicare regulations. Ideal candidates will have excellent attention...Remote jobHourly payWork at office- ...Job Title: Appeals & Grievance Specialist Job ID: 89227 Location: Boulevard, Irving Overview: The Appeals & Grievance Specialist II is responsible for independently researching, reviewing, and resolving member and provider inquiries, complaints, appeals, and grievances...Work at officeMonday to Friday
$25 - $29 per hour
...Innova Solutions has a client that is immediately hiring for Appeals & Grievances Specialist Position type: Full-time - Contract Duration: 3 Months Location: Philadelphia, PA As an Appeals & Grievances Specialist, you will: Manage assigned appeals...Hourly payFull timeContract workTemporary workWork experience placementImmediate startWorldwideFlexible hours- ...denials, member and provider complaints, and reconsideration and redetermination requests. Review and respond to complaints, grievances and appeals within the stated time frame for each request. Certify that providers and members are reimbursed accordingly using...
- A healthcare service company is seeking a G&A Coordinator in Detroit, MI. This role involves processing appeals, grievances, and inquiries from members, requiring strong analytical and communication skills. The ideal candidate will have a bachelor's degree and experience...
$48.5k - $70.5k
...year history of providing health insurance that works for our members, no matter their circumstances. Job Summary The Appeals and Grievance Specialist is responsible for managing the resolution process of medical and pharmacy member appeals and/or member generated...Contract workWork at officeFlexible hours- Collabera is seeking an experienced Appeals & Grievances Specialist in Texas to support healthcare members and providers. You will research and resolve appeals, grievances, and complaints, and review claims, benefits, records and contracts to prepare timely resolutions....
$22 - $25 per hour
...communities." Western Health Advantage Western Health Advantage (WHA) is seeking a detail-oriented and customer-focused Appeals & Grievances Specialist to join our team. In this fast-paced role, you will support members by managing appeals and grievances while ensuring...Hourly payWork experience placement$31.25 - $33.65 per hour
...Appeals Specialist Remote GeneDx delivers personalized and actionable health insights to inform diagnosis, direct treatment, and improve drug discovery. The company is uniquely positioned to accelerate the use of genomic and large-scale clinical information to enable...Remote workWork at officeWork from homeHome office$28 - $35 per hour
...Location: Remote (U.S.) Preferred Location: Candidates based in or near Beachwood, OH are strongly preferred. Reports To:... ...Madison Industries, on a direct hire opportunity for a Denials & Appeals Specialist. This is a remote revenue cycle role focused on...Remote workHourly payWork at officeLocal area- ...Researching and responding to inquiries from various stakeholders, the full-time Appeals Specialist will manage the appeals/dispute process remotely, ensuring timely and accurate customer service and resolution of issues. Key responsibilities Provides customer service...Remote workFull timeContract workFor contractorsWork at office
$27 per hour
...Our client, a leading healthcare organization, is seeking a Grievance & Appeals Specialist I to join their team. As a Grievance & Appeals Specialist I, you will be part of the healthcare operations department supporting member and provider relations. The ideal candidate...Permanent employmentContract workTemporary workMonday to FridayFlexible hoursShift work$29.7 - $31.8 per hour
...between $29.70 - $31.80 based on experience The Acute Coding Appeals Specialist integrates medical coding principles and objectivity in the... ...and improve patient and client experiences. ~ This is a remote position; however, candidates must be willing and able to travel...Remote workTemporary workWork at officeLocal area- Molina Healthcare in Kentucky is seeking a Claims Support Specialist to review and resolve member and provider complaints and communicate... ...in line with CMS standards. The role involves researching appeals and grievances, requesting and reviewing medical records and bills,...Contract work
- ...Overview: Respond to all assigned levels of denials by submitting appeal letters and required documentation to insurance companies within... ...plan and work with the patient to get the denial overturned. Remote: Although this position is listed as remote, the training period...Remote work
- UT Southwestern Medical Center is seeking a Technical Denials Management Specialist II in the Revenue Cycle Department to review, research, and resolve claim denials and appeals for various insurers, while identifying payment trends to maximize collections. This WFH role...Remote jobWork at officeWork from home
- ...UnitedHealthcare is seeking an Appeals and Grievances Medical Director to lead clinical review and adjudication across multiple plans. The role... ...collaboration with medical directors and network management. Remote work within the U.S. is supported, with a focus on improving...Remote work
$25 - $31 per hour
...Responsible for all activities associated with appeal analysis, decision-making and closure as... .... Collaborate effectively with coding specialists, appeal nurses, physician reviewers, and... ...) Workplace Type This is a fully remote position. Application Deadline This...Remote workContract workTemporary workWork experience placement- Aspirion is seeking a Denials Appeals Specialist to analyze denial reasons, draft and submit appeals, and support improved cash flow. You will... ...experience in healthcare revenue cycle or denial management. Remote work within the United States is allowed. #J-18808-Ljbffr...Remote job
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