Remote Grievance & Appeals Specialist
RiseMe
- Remote job
Luminare Health is seeking a Grievance & Appeal Specialist to address and handle appeals within required timeframes and ensure compliance with regulatory standards and contractual obligations. The role requires strong knowledge of Medicare CMS guidelines, medical claims experience, and the ability to work independently in a fast-paced environment while collaborating with team members. #J-18808-Ljbffr RiseMe
- ...Luminare Health is seeking a Grievance & Appeal Specialist to address and handle appeals within required timeframes and ensure compliance with regulatory standards and contractual obligations. The role requires strong knowledge of Medicare CMS guidelines, medical claims...Remote work
- ...Managing the resolution process for medical and pharmacy member appeals and grievances, the full-time remote Appeals and Grievance Specialist will ensure compliance with regulatory requirements and accreditation standards while coordinating with internal and external stakeholders...Remote workFull time
$46.37k - $60.86k
...Hi, we're Oscar. We're hiring a Specialist, Admin Complaints, Grievances & Appeals to join our CGA & MPCT team. Oscar is the first health insurance company... ...into our CGA Team Lead. Work Location: This is a remote position, open to candidates who reside in: Arizona,...Remote jobFull timeWork at office$60.78k
...Select how often (in days) to receive an alert: Appeals and Grievances Specialist II Job Category: Customer Service Location: Los Angeles, CA, US,... ...requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical...Remote workFull timeLocal areaShift workWeekend 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$23 per hour
TEKsystems is seeking a Contract Grievances and Appeals Specialist for a fully remote role based out of Columbus, OH. The position analyzes and resolves verbal and written claims and appeals from providers and members, and prepares response letters. This is a contract...Remote jobHourly payContract 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
$48.9k - $70.78k
...serve. The Job The GAD Triage Specialist is responsible for implementing, analyzing... ...~0-3 years of related (Grievance and Appeals, and ERP systems) experience. ~ Prior... ...Triage Specialist ~ Work Mode: Mostly Remote ~ An annual employee bonus program...Remote workHourly payFull timeFor contractors$37.59k - $70.55k
...affordable. Job Summary The primary responsibility of the Grievance & Appeal Specialist is to address and handle the appeals received within... ...healthcare claims environment) This is a Telecommute (Remote) role. Remote employees must live within the continental...Remote workFull time$23 - $26 per hour
...applications and next steps. Our partner is looking for a Grievance Specialist based in the United States. This fully remote role focuses on resolving member grievances... ...experience handling Medicare Advantage appeals and grievances ; Medicare experience is required...Remote workHourly payFull time$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- ...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...
- AppleOne Employment Services seeks a Grievance and Appeals Specialist to analyze and process non-complex health plan grievances and appeals with a focus on regulatory alignment and clear written communication. You will review cases from members, providers, and third parties...
- Alameda Alliance for Health in California is seeking a Grievance and Appeals Coordinator II who reviews, investigates, and processes non-complex member grievances for all lines of business. You will prepare written determinations and maintain documentation in the electronic...
- Kelsey-Seybold Clinic in Pearland, part of the Optum family, seeks an Appeals & Grievances Coordinator to manage Medicare reconsiderations, grievances, and appeals, ensuring CMS regulatory compliance and timely resolutions. You will collaborate with Medical Director, Clinic...
- ...Managing and processing appeals efficiently, the Appeals Specialist II will work in a flexible environment with both remote and on-site options, reviewing case documentation and communicating with clients to resolve issues. Key responsibilities Manage and process appeals...Remote workFlexible hours
- 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
$16 - $18.45 per hour
...Position: Appeals Specialist Location: Remote, US Salary: $16.00-18.45 hourly Overview J29, Inc. (J29) has been supporting commercial, State, and Federal health and human service programs since company inception in 2017 as a healthcare management consulting...Remote workHourly payFull timePart timeFor contractorsWork at office- 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
- Aspirion in Delray Beach, FL is seeking a Denials Appeals Specialist to analyze denial reasons, draft persuasive appeal letters, and submit appeals to insurance carriers. Your work will support cash flow, reduce aging, and minimize revenue leakage through timely, high-...Remote job
- UT Southwestern Medical Center in Dallas, TX, seeks a Technical Denials Management Specialist II to review, research, and resolve claim denials and appeals for various insurers, maximizing collections. The role emphasizes follow-up and resolution of denied claims with...Remote job
$59 - $60 per hour
WE’RE HIRING: REMOTE REGISTERED NURSE (RN) 100% REMOTE | MONDAY-FRIDAY | $59-$60/HR We are looking for experienced Registered Nurses... ...Management experience Prior Authorization experience Grievance & Appeals experience preferred, but not required #J-18808-Ljbffr PhaxisRemote workMonday to Friday$59.25k - $94.8k
...Omaha, NE (Nebraska); Work from Home Work Arrangement: Remote : Work at home employee residing outside of a commutable distance... ...We are excited to bring on a Short Term Disability Appeals Specialist to our team within Workplace Solutions. As an Appeals Specialist...Remote workFull timeContract workTemporary workWork experience placementWork at officeWork from homeRelocation package- ...California is seeking an entry-level analyst in the Enterprise Grievance & Appeals Department to review and process non-complex pre-service and... ...staff as needed, while adhering to URAC and NCQA standards. Remote work is allowed with some onsite requirements in California....Remote jobContract work
- Banner Plans & Networks is seeking a Grievance and Appeals Coordinator to manage intake, review, investigation, and resolution of grievances,... ...providers to ensure compliant, timely responses. Position primarily remote with Arizona residency required for consideration; standard...Remote jobMonday to FridayShift work
- Elevance Health in California seeks an entry-level Grievances & Appeals Analyst to support non-complex grievances and appeals, across multiple products, with emphasis on clear written communication and regulatory awareness. You will research claims and medical records,...Remote job
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