Appeals & Grievance Specialist - Resolve & Improve Care
CVS Health
CVS Health is looking for an Appeals Specialist to manage intake, investigation, and resolution of appeals, complaints, and grievances for all products. You will coordinate with multiple business units to ensure timely and customer-focused responses while identifying trends and potential improvements. The role requires 1-2 years in claims platforms or related areas, strong analytical skills, and familiarity with benefit language. #J-18808-Ljbffr
- ...Molina Healthcare is seeking a Claims Appeals Specialist to support claims activities, review member and provider complaints, and communicate... ...in line with CMS standards. You will research appeals and grievances, request and review medical records, prepare summaries, and...SuggestedContract work
- ...claims activities including reviewing and resolving member and provider complaints, and... ...research and resolution of appeals, disputes, grievances, and/or complaints from Molina members... ...Qualifications At least 2 years of managed care experience in a call center, appeals,...SuggestedContract workWork at officeRemote work
- ...Molina Healthcare is seeking a detail‑oriented claims professional to support appeals, disputes, grievances, and complaints from members, providers, and external agencies. You will research and resolve issues to ensure timely, compliant outcomes under CMS guidelines....Suggested
$51k - $74.88k
...The Appeals & Grievances (A&G) unit processes member and non-contracted... ...enrollments Medicare and complete care. Appeals Specialist is the subject matter... ...for investigating and resolving member or non-contracted... ...leadership for process improvement. Remain up to date on...SuggestedFull timeTemporary workWork experience placementRemote work- 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...SuggestedRemote work
- ...Molina Healthcare is seeking a claims appeals specialist to support member and provider disputes, appeals, and grievances in accordance with CMS standards. The role emphasizes... .... Required experience includes managed care claims or equivalent, Medicaid/Medicare processing...
- MJHS in New York, NY seeks an A&G Coordinator to investigate and respond to member and provider appeals and grievances under CMS and DOH rules. In a non-clinical role, you will help ensure timely decisions and accurate documentation. You will determine the appropriate...
$1,000 per month
...Position: Reimbursement Specialist Location: Franklin, TN... ...has been committed to improving the lives of all who entrust us with their care and those who we... ...include reviewing claims, resolving billing discrepancies,... ...as well as submitting appeals. Communication with various...Work at office- ...directly support better patient care. Join Brightree by ResMed as... ..., payors, and states, helping improve financial performance through... ...management, denial resolution, appeals support, and revenue recovery... ...cross-functional collaboration to resolve operational challenges, remove...Work at officeImmediate start
- ...Bundesverband der Personalmanager e.V. seeks to fill a remote position overseeing utilization management and complex appeals processes for US members and providers. The role requires clinical expertise and regulatory awareness within a globally distributed team. Candidates...Remote work
$37.5 - $54.25 per hour
...Quality, compassionate care for all. Our Vision:... ...Utilization Management Specialist to join our dedicated... ...for process and system improvement and initiates and leads... .... Identifies and resolves delays and obstacles as... ...Assists with preparation of appeal letters for insurance...Full timeImmediate startRemote work10 hours per weekShift workRotating shiftWeekend workDay shiftAfternoon shift- ...that by providing quality care that is both evidence-based... ...a Psychiatric Complaints & Grievances Specialist to join our Psych Clinical... ...clear and fair determinations, resolve and document each case... ...energized by clinical quality improvement, comfortable holding a standard...Full timeLive inCurrently hiringRemote workHome office
- ...most: delivering quality care to their clients. As an RCM Specialist II, you will serve as a... ...owners by managing accounts, resolving complex billing... ...-solving and continuous improvement. The ideal candidate embraces... ..., denial management, appeals, and accounts receivable...Work at office
- Aspirion is seeking a Denials Appeals Specialist to analyze denial reasons, draft and submit appeals, and support improved cash flow. You will work with carriers and internal teams to resolve claims and minimize revenue leakage. Ideal candidates bring strong analytical...Remote job
- ...comprehensive and compassionate care to the communities we... ...by our mission to improve the health of the... ...hiring a Technical Denials Specialist! This position is... ...responsible for analyzing, resolving, monitoring and... ...follow‑up, completes appeals and referrals to other...Full timeContract workWork at officeLocal areaRemote workFlexible hoursDay shift
$39.4 - $51.47 per hour
...providing progressive, quality patient care with significant investments in our exceptional... ...Pay Range: $39.40 - $51.47 Facilitates improvement of overall quality and completeness of... .... Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Improvement...Full timeTemporary workPart timeFlexible hours$17 - $23 per hour
...healthcare: quality clinical care with positive patient experiences... ...and deliver revenue cycle improvement services that enable their... ...for payments or adjustments to resolve claim Contacts payers via phone... ...claims; reconsideration and appeal submission. Adhere to state...Local area$93k - $116.2k
...dare to act, and deliver with care and passion. At Pandora where... .... Your Role as Payroll, Specialist:A Payroll Specialist under the... ...coordination and continuous improvement of current business processes... ...centric mindset. Research and resolve payroll issues through Zen Desk...Work at officeLocal areaWorldwide- ...seeking a MDS Coordinator to manage coordination of MDS assessments for residents and support clinical staff in delivering high quality care. The role requires at least 2 years of MDS 3.0 experience in long-term care, NY RN licensure, and RAC-CT readiness. Strong...
$45k
...SCOPE OF ROLE: The Housing Specialist supports SSVF program... ...possible) with landlords. Appeal tenant selection decisions.... ...Join a team of employees who care about the wellbeing of others... ...individualpotentialand continuous quality improvement.From health and wellness...Permanent employmentTemporary workLocal areaWork from home- ...Empower. Unite. Care. MetroPlus Health is committed to... ...,000 primary care providers, specialists and participating clinics. For... ...term housing goals in order to improve members overall quality of... ...(i.e., application process, resolving issues with landlords, rights...Immediate startWork from homeShift work
- ...Burn Center, Surgical Intensive Care Unit, regional Stroke Center,... ...record. Monitors denials and appeals. Performs DRG denial reviews... ...with opportunities for improvement. Evaluates root causes and proposes... .... Confers with coding specialists, and oversees and evaluates work...
- ...high-volume work of chronic care – monitoring patients, surfacing... ...real-world care delivery, improving as it scales. Cadence has been... ...re hiring a Leave of Absence Specialist to run the day-to-day operations... ...through return to work, resolving routine questions under established...Local areaRemote workHome officeShift work
- ...should be an expression of love, care, and taste. About the Role The Temporary CX Specialist will keep our concierge-level... ...knowledge or guidance so we can improve our automation after the holiday... ...unhappy customers. Respond to and resolve customer inquiries in Gorgias with...Temporary workLocal areaRemote workWeekday work
$18 - $25 per hour
...delivering exceptional patient care. That’s why we’ve built a... ...streamline their workflows, improve provider satisfaction, and accelerate... ...efficiently. The Licensing Specialist Contractor is responsible for... ..., etc.) Monitor for and resolve deficiencies, including Board...Full timeContract workFor contractorsFor subcontractorWork at officeLocal areaRemote work- ...program. We are seeking a Program Specialist to join our rapidly growing... ...team that integrates medical care, behavioral support, and... ...help members achieve lasting improvements in their quality of life. Ria... ...challenges and take action to resolve them. Other duties as assigned...Part timeRemote workFlexible hoursWeekend work
$90k - $95k
...Title: Leave & Accommodation Specialist Job Summary: The Leave & Accommodation... ..., continuous process improvement, and the ability to... ...lines to address unique needs, resolve escalations, and provide strategic... ...leading North American pet health care company with nearly 1,300...Temporary workWork experience placementWork at officeLocal area- ...Finance LP is seeking an Invoice Management Specialist to ensure accurate processing,... ...procurement and internal stakeholders to resolve discrepancies, meet SLAs, and contribute... ...systems while driving invoice workflow improvements. Ideal candidates have 2–5 years in mortgage...
- .../They will assist in the coordination of care both prior to and following a genetic counseling... ...as needed.Additional supportAnswer and resolve routine phone inquiries or email requests... ...assistants when absent.Continue to improve workflow including steps related to patient...Hourly payTraineeshipWork at officeLocal area
- ...inspires consumers to pay more attention; to care more about our clients' brands; and to... ...teams to optimize their setups and resolve complex campaign challenges. Performance... ...performance, identifying trends and areas for improvement. Continuously refine and share insights...Local areaRemote workFlexible hours
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