Remote Appeals & Grievances Specialist
Acentra Health, LLC
- Remote job
Acentra Health is seeking an Appeals and Grievance Specialist to join our growing team. You will conduct thorough research and investigations to resolve complaints and appeals, oversee outcomes, and ensure prompt completion of the process. This is remote with core hours in the Eastern Time Zone. Required: high school diploma or GED. Associate's degree and 1+ year in customer service preferred. Proficiency in MS Word and Outlook, strong written and verbal communication, and solid organizational #J-18808-Ljbffr Acentra Health, LLC
- ...Network Health is seeking an Appeals and Grievance Specialist I to join our Wisconsin team. The role reviews member appeals, investigates findings... ...strong communication and regulatory interpretation skills. Remote 1.0 FTE, with occasional travel to offices in Menasha or...Remote work
$30.7k - $66.5k
...Medicare and Medicaid Services (CMS). Essential Job Duties • Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory...Remote workFull timeContract workWork at office$60.78k
...Appeals and Grievances Specialist IIJob Category: Customer Service Department: Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type... ...work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical...Remote workFull timeLocal areaShift workWeekend 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...Remote work
- Banner Health is seeking a Health Plans Grievance and Appeals Coordinator in a remote role. You will manage grievances, appeals, and disputes for members and providers, ensuring timely investigations and communications. The role requires knowledge of AHCCCS, HCG, CMS rules...Remote job
- Banner Plans & Networks in Arizona seeks a Grievance and Appeals Coordinator to manage the intake, review, investigation, and resolution of member grievances, appeals, and provider disputes in a remote setting. Candidates must reside in Arizona; you will document findings...Remote job
- Harbor Health in Texas seeks an Appeals & Grievances Specialist to investigate, process, and resolve member and provider complaints, grievances, and appeals. This fully remote role focuses on Texas IFP/Marketplace and large-group products, ensuring timely investigations...Remote job
- Humana, Inc. is seeking a Grievances & Appeals Representative to manage member and provider inquiries, investigate concerns, and deliver timely... ...application, and collaboration across teams in a primarily remote setting. The position requires prior customer service...Remote jobMonday to FridayShift 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- Job Category Appeals, Grievances, Specialist Employee Type Exempt - FT Manage Others No Contact information Phone (***) ***-**** Email ****@*****.***... ...provider complaints, grievances, and appeals. This fully remote position focuses primarily on supporting our Texas fully...Remote workHome office
- Phaxis is seeking an experienced RN to own grievance and appeals cases from intake to final decision in a fully remote setting. You will handle outpatient and community-based care grievances, applying medical necessity criteria and regulatory rules. The ideal candidate...Remote job
$56.27k - $69.9k
Pay Plan Title: Appeals or Grievances Specialist II Working Title: Appeals Specialist II FLSA Status: Exempt Posting Salary Range: $56,270 - $69,898 Office Location: Remote within North Carolina POSTING DETAILS: Make an Impact Trillium Health Resources is...Remote workFull timeWork at officeLocal areaImmediate startWork from homeFlexible hours- A-Line is seeking a Remote Appeals Coordinator to support processing of Medicare member and provider appeals and grievances. The role screens for urgency, benefit coverage, and medical necessity, routing cases to the appropriate analyst. Responsibilities include investigations...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- AHCCCS in Phoenix seeks an Advocacy Program Specialist to deliver Special Assistance for... ...and help protect rights while navigating grievance and appeals processes. The role requires travel within the Phoenix area and possible remote work based in the Phoenix Metropolitan...Remote job
- Centene in Tempe, AZ is hiring for a full-time position focused on analyzing and resolving verbal and written claims, appeals, and grievances from providers and members. The role requires in-office presence in Tempe, with mailroom activities and related duties. Responsibilities...Full timeWork at office
$66.3k - $79.8k
Overview Resolves grievances, appeals and external reviews for VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Fully Integrated Dual Advantage (FIDA) and Select Health. Ensures regulatory compliance, timeliness requirements and accuracy...Work experience placementWork at officeFlexible hours- 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...
- A national recruiting company is seeking a Business Grievance/Appeals Representative in Cerritos, California. The ideal candidate will review, analyze, and process claims, conduct investigations into customer grievances, and ensure proper communication with customers. Candidates...Contract work
- CVS Health in Ohio seeks a specialist to handle intake, investigation and resolution of appeals, complaints and grievances across multiple products. You will coordinate responses from multiple business units and ensure timely, customer-focused communication to members and...
- CVS Health is seeking a detail-oriented professional to manage intake, investigation, and resolution of appeals, complaints, and grievances across products. You will coordinate responses from multiple units and ensure timely, customer-focused resolutions. The role requires...
- Centene is hiring an in-office Grievances and Appeals Specialist in Tempe, AZ to analyze and resolve verbal and written claims and authorization appeals from providers and members. The role requires full-time availability and residence in Arizona. You will gather and report...Full timeWork at office
$19.43 - $32.98 per hour
Centene Management Company LLC in Tempe, AZ is seeking a claims, grievances and appeals specialist to analyze and resolve verbal and written appeals from providers and respond to member grievances. The role requires residency in Arizona, a high school diploma (associate...Hourly payWork at officeFlexible hours- SafeRide Health is seeking an experienced Complaints and Grievance Coordinator responsible for processing complaints and grievances, including member grievances, appeals, and provider disputes. The role ensures cases are resolved according to client-specific requirements...
- CVS Health is seeking a detail-oriented professional to manage intake, investigation and resolution of appeals, complaints, and grievances across products. You will coordinate responses from multiple teams, identify trends, and propose solutions while ensuring timely, customer...
$56.2k - $101k
...Position Purpose: Supervise the day to day operations of the Appeals and Grievance (A&G) staff and functions within the department ensuring... ...and distribute case load. Key Details : This position is remote/work from home. The role will support the states of Delaware...Remote workFull timePart timeWork at officeWork from homeMonday to FridayFlexible hoursWeekend 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
$246.1k - $344.2k
...and reviews of medical records for appeals decisions. The Corporate Medical Director... ...or oversee clinical reviews of grievance and appeal cases for assigned... ...Neurology, and General Surgery clinical specialists Work Style: Fully remote living in the contiguous USA....Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to FridayWeekend work$19.13 - $34.17 per hour
...Adjudicating Complex Non-Utilization. Management Appeals According To The Appropriate Federal,... ...And Mentor Less Experienced Appeals Specialists. JOB REQUIREMENTS: * High School... ...plan. This position may be performed remotely from anywhere within the continental United...Remote work$50k - $60k
...funded and fully funded programs, and delivered tangible savings and enhanced experiences for millions of members. The Appeals & Disputes Specialist is responsible for reviewing, investigating, and resolving member appeals and provider disputes for benefit plans,...Remote workFull timeWork at office
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