Remote Grievances & Appeals Specialist
Humana
Phoenix, AZ
- Remote job
Humana, Inc. is seeking a Grievances & Appeals Representative 2 to manage client denials and concerns by conducting analytic reviews of clinical documentation and delivering final determinations in a production-driven environment. This remote role supports members and providers, applying Humana policies to ensure quality service. The position requires prior customer service experience, healthcare familiarity, and proficiency with Word and Excel, with an 8-hour shift Monday–Friday 8am–8pm and #J-18808-Ljbffr Humana
Vacancy posted 2 days ago
Similar jobs that could be interesting for youBased on the Remote Grievances & Appeals Specialist in Phoenix, AZ vacancy
- ...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
Network Health
Menasha, WI3 days ago - ...Acentra Health is seeking an Appeals and Grievance Specialist to join our growing team. You will conduct thorough research and investigations to resolve... ..., and ensure prompt completion of the process. This is remote with core hours in the Eastern Time Zone. Required: high...Remote work
Acentra Health, LLC
Salem, OR1 day ago $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 workLOS Angeles Care Health Plan
Los Angeles, CA13 hours ago$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...Remote workFull timeContract workWork at officeWeekend 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
Health First
United States1 day ago - Centene Corp. is seeking a remote Grievance & Appeals Coordinator II for Centene Pharmacy Services. You will analyze and resolve member and provider grievances and appeals, coordinating with internal teams and health plan partners, while ensuring regulatory compliance....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
- 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
- Centene is seeking a California-licensed nurse (RN or LPN/LVN) for a remote role aligned to Pacific Standard Time hours. You will facilitate medical necessity grievances, appeals, and denials, review clinical data, and determine if criteria are met under NCQA guidelines...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- HealthFirst is seeking a Grievance Specialist for the 100% remote Appeals & Grievances team. You will manage member grievances end-to-end, investigate with cross-functional partners, and ensure timely, compliant resolutions within regulatory standards. The role emphasizes...Remote job
$58.9k - $80.07k
The Grievance Specialist is a member of the Appeals & Grievances (A&G) team at Healthfirst and is responsible for managing and resolving member or authorized... ...regulatory requirements. **This position is 100% remote - Schedule M-F, 8am-4:30pm or 8:30am-5pm EST Key Responsibilities...Remote jobContract workTemporary workWork experience placementWork at office- ...contract role with a New York health plan. You will own clinical grievances and appeals from intake to final decision letters, applying medical... ...judgments based on InterQual/MCG criteria. The position is 100% remote in the United States, with business hours and occasional...Remote jobContract workAfternoon shift
- ...Job Description Job Description Description: 100% REMOTE CANDIDATES MUST LIVE IN ONE OF THE PREFFERED 15 STATES... ...Responsible for the comprehensive research and resolution of the appeals, dispute, grievances, and/or complaints from Client members, providers and...Remote workContract workLive inMonday to Friday
Integrated Resources, Inc
Dallas, TX18 days ago - 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...
$62k - $75k
As the Grievance and Appeals Specialist, you will be responsible for independently resolving member and provider grievances and appeals within applicable state Medicaid, federal, contractual, and accreditation timeframes. You will work directly with members, providers,...Contract workWork experience placementLocal area- 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...
- 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
- Commission on Medical Care in California is seeking a Grievance & Appeals Investigator to review, investigate, and resolve member grievance and appeal cases ranging from low to high complexity in Fairfield, Redding, Eureka, and Chico. You will transform member dissatisfaction...
- VNS Health seeks a Grievance and Appeals Specialist to resolve grievances and appeals for MLTC, MA, FIDA, and Select Health plans in a hybrid New York environment. The role ensures regulatory compliance, timely processing, and accurate record-keeping of decisions. Responsibilities...
- 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...
$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- ...Partner Company is a healthcare organization focused on pediatric care and research, seeking a specialist to manage denial and appeal follow-up within a fully remote team. The role requires working with revenue integrity teams and leveraging tracking systems to monitor...Remote work
Partner Engineering and Science
New York, NY1 day ago - ...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...
Macpower Digital Assets Edge Private Limited
Irving, TX18 days ago - ...Supporting the documentation and processing of appeals, the full-time Appeals Specialist II will manage appeals, disputes, and reconsiderations to ensure... ...with state and NCQA requirements while working remotely. Key responsibilities Perform data entry to track, log...Remote workFull timeVisa sponsorshipWork visa
Virtual Vocations Inc
United States1 day ago - ...Intelligent Solutions is seeking a Denials Specialist for a contract-to-hire role in Skokie, IL. You will own end-to-end denial and appeal workflows, audit data, and drive timely... ...for 1–2 weeks, then transitions to fully remote work. You will collaborate cross-functionally...Remote workContract work
LaSalle Intelligent Solutions
Skokie, IL1 day ago - ...Centers for Medicare and Medicaid Services (CMS).Essential Job Duties• Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina providers, and related outside agencies to ensure that internal and/or regulatory...Hourly payContract workWork experience placementWork at office
Molina Healthcare
Jacksonville, FL13 hours ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote Grievances & Appeals Specialist. Be the first to apply!
Related searches
- patient safety specialist Phoenix, AZ
- credit card specialist Phoenix, AZ
- senior specialist Phoenix, AZ
- zoning specialist Phoenix, AZ
- health program specialist Phoenix, AZ
- youth specialist Phoenix, AZ
- microsoft specialist Phoenix, AZ
- transportation specialist Phoenix, AZ
- color specialist Phoenix, AZ
- hearing specialist Phoenix, AZ