Remote Appeals Specialist - Non‑Medical & Redeterminations
260 CGS Administrators, LLC
- Remote job
BlueCross BlueShield of South Carolina is seeking an Appeals Specialist to perform non-medical reviews and process redetermination letters, ensuring timeliness and accuracy. The role requires at least 2 years of relevant experience, strong Microsoft Office skills, and excellent organizational and communication abilities. Onsite or remote work options are available, with shift hours during Central Time. This position also offers comprehensive benefits including health, dental, 401(k), life #J-18808-Ljbffr 260 CGS Administrators, LLC
- BlueCross BlueShield of South Carolina is seeking an Appeals Specialist to perform non-medical reviews and process redetermination letters. The role supports timely and accurate decision making and requires proficiency with Microsoft Office and strong communication skills...MedicalWork at office
- ...detail-oriented Reimbursement Specialist – Appeals to join our team and support... ...reimbursement. ~Fully remote role (U.S.-based) with occasional... ...~Strong understanding of medical benefit structures,... ...parental status, military service, or other non-merit factor....Remote workMedicalFull time
$50k - $55k
...Under the direction of the Appeals Department leaders, the... .... The Appeals Specialist level II performs research... ...all appeals from Non-Participating providers... ...frequent interruptions Remote Work Requirements... ...- We offer excellent medical, dental, and vision plan...Remote workMedical- ...environment. Premier medical, dental, vision, and dependent... ...work environment with remote/Home Office options,... ...Transformation Specialist to support major initiatives... ...Conditions Of Employment & Appeal Rights Minimum... ...Part‑Time (40% PTE) and non‑exempt; overtime requires...Remote workMedicalTemporary workPart timeWork at officeWork from homeHome officeFlexible hoursWeekend workAfternoon shift
- Summary We are currently hiring for an Appeals Specialist to join BlueCross BlueShield of South... ...Specialist, you will be required to perform non-medical reviews and process redetermination... ...overtime. This role is fully remote or can sit onsite at 26 Century Blvd,...Remote workMedicalFull timeContract workFor contractorsWork experience placementSecond jobCurrently hiringWork at officeLocal areaShift work
- ...Working remotely in a full-time capacity, the Appeals Specialist will leverage expertise in claims adjudication and risk management to guide clients through the... ...issues as needed Renders appeal decisions using medical, vocational, and legal resources, serving as a technical...Remote workMedicalFull timeContract work
- ...Senior Appeals Specialist Job Category: Medical Billing Full-Time Remote Middleburg Heights, OH 44130, USA +1 more locations Description Key Responsibilities: Work as needed in all appeal worklists, potentially with a focus on contracted or sensitive...Remote workMedicalFull time
$19 - $21 per hour
...Appeals Specialist Respond to all assigned levels of denials by submitting appeal letters and required... ...patient to get the denial overturned. Remote: Although this position is listed as... ...patient and/or physician consent and medical records when required by the insurance...Remote workMedicalHourly pay- ...Physician Associate to review and adjudicate appeals and grievances across multiple health plans. You will work under medical direction in a multidisciplinary team to ensure... ...high standards of care. This full-time remote role requires state PA licensure, NCCPA certification...Remote jobMedicalFull time
- Maximus is seeking a Senior Appeals Administrator for their California Independent Medical Review team. This role is vital in ensuring timely resolutions for medical review cases while enhancing the appeals process. The ideal candidate will have an associate degree with...Remote jobMedicalWork from homeFlexible hours
- ...perform ongoing clinical review and adjudication of appeals and grievances. You will collaborate with a team of medical directors, physician associates, and appeals... ...HMO, MAPD, and PDP programs. The role supports remote work within the United States, with standard Monday...Remote jobMedicalMonday to Friday
- ...Physician Associate to review and adjudicate appeals and grievances across multiple health plans. You will join an integrated team of medical directors, physician associates, and... ...staff to deliver timely determinations. This remote role requires a current PA license, NCCPA...Remote jobMedicalWeekday work
$19 - $23 per hour
...Intake Specialist (In-Office if Local / Remote if Non-Local) Full Time Boise, ID, US 18 days ago Requisition ID: 1702 Salary Range: $19.00 To $23.00 Hourly... ...will develop a skin condition requiring expert medical care. We believe that every person deserves the very...Remote workMedicalHourly payFull timeLive inWork at officeLocal areaMonday to Friday- CorVel Corporation in Fort Worth, TX is looking for an Appeals Representative to manage provider inquiries and appeals efficiently following... ...A comprehensive benefits package is available for full-time employees, including medical and retirement plans. #J-18808-Ljbffr CorVelRemote jobMedicalFull time
$51.4k - $68.35k
...communities. About the Opportunity As an Appeals Specialist at MVP Health Care, you will play a... ...improvement Location Hybrid – combine remote and in‑office work as approved by the manager... ...disability, handicapping condition, medical condition, pregnancy status, predisposing...Remote workMedicalWork at office- ...Expedited Appeals Specialist Responsible for processing expedited appeals: those that are complex in nature, require multiple hand-offs... ...investigation to appropriately resolve all inquiries; prepare cases for medical and administrative review detailing the findings of their...Remote workMedicalHourly payContract workWeekend work
- CorVel Corporation in Fort Worth, Texas, seeks an Appeals Representative responsible for managing provider inquiries related to healthcare... ...customer service. A comprehensive benefits package including medical, dental, and retirement plans is available for full-time staff....Remote jobMedicalFull time
- L.A. Care Health Plan is seeking an Appeals and Grievances Specialist II in Los Angeles, CA. The role involves investigating member and provider complaints... ...include at least 2 years in Managed Care, knowledge of medical terminology, and excellent communication skills. This...Remote jobMedicalFull time
- ...Appeals Specialist We are seeking a detail-oriented and experienced Appeals Specialist for our... ...is highly organized, knowledgeable in medical billing and payer requirements, and skilled... ...Friday 8am-5pm 3 months in office then remote Benefits offered Key responsibilities...Remote workMedicalWork at officeMonday to Friday
- ...positions are classified as hybrid, onsite or remote. While the majority of our employees are... ...to requests for member and provider appeals, grievances, reconsiderations and corrected... ...(PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG) Level...Remote workMedicalFull timeContract workWork experience placementWork at officeLocal area1 day per week
- ...Denials Specialist Insight Global is seeking a fully remote Denials Specialist to support a Healthcare AI client. This... ...will leverage their denials and appeals expertise to evaluate and improve... ...strategies across various denial types (medical necessity, authorization, coding,...Remote workMedicalContract workPart timeMonday to FridayFlexible hoursShift 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... ...grievance outcomes. Requests and reviews medical records, notes, and/or detailed bills as...Remote workMedicalHourly payFull timeContract workWork experience placementWork at office$60.78k
Appeals and Grievances Specialist II Job Category: Customer Service Location: Los Angeles, CA, US, 90017... ...Managed Health Care (DMHC), Managed Risk Medical Insurance Board (MBMIB) and National... ..., on weekends, holidays, a hybrid remote schedule, occasional flexibility in...Remote workMedicalFull timeLocal areaShift workWeekend work- ...is seeking a Physician Assistant to join the Appeals & Grievances team. You will adjudicate... ...appeals across multiple plans, collaborating with medical directors and the appeals staff to support coverage decisions. This remote U.S. role requires NCCPA certification, a PA...Remote jobMedicalMonday to Friday
$28.85 - $35 per hour
...Denials & Revenue Recovery Specialist for a fast-growing... ...organization . This is a fully remote role (U.S.-based, any... ...) supporting specialty medical practices nationwide.... ...denial queues, submit appeals, and follow claims... ...equitable, inclusive, and non-biased talent and recruitment...Remote workMedicalHourly payTemporary workInterim roleFlexible hours- ...management. For over 30 years, MDS has successfully partnered with multiple hospitals and respected health systems across the nation. Medical Data Systems Inc. is seeking a professional, self-sufficient, highly motivated dependable person to work in our patient billing...Remote workMedicalWork at office
- ...Accounts Receivable Specialist New England Life Care... ...and is the region's only non-profit home infusion provider... ...Specialist is a remote position and is responsible... ...requirements for basic appeals Demonstrate... ...Demonstrated knowledge of medical terminology; CPT; ICD9;...Remote workMedicalTemporary workWork at officeLocal areaWork from homeMonday to Friday
$20 - $22 per hour
...Job Title Credit Balance Specialist Industry Healthcare... ...Cycle Management Location (Remote) Remote (Candidates... ...position is eligible for medical, dental, vision, and 40... ...credit balances, denials, appeals, insurance follow‑up,... ...local laws governing non‑discrimination in employment...Remote workMedicalHourly payFull timeContract workLocal areaImmediate startMonday to FridayFlexible hours- ...highest quality, evidence-based medication assisted treatment (MAT)... ...Day in the Life of an AR Specialist Performs all duties and... ...claims, governmental and/or non-governmental claims, denied claims... ...payment discrepancies. Prepare appeal letters for technical denials...Remote workMedicalContract workTemporary workWork at officeLocal area
$25 - $31 per hour
Veracyte is looking for a mid-level Reimbursement Specialist in South San Francisco to ensure timely reimbursement processes. You will... ...navigating payor portals. The ideal candidate has 2+ years in medical billing and strong analytical skills. This full-time role offers...Remote jobMedicalHourly payFull time
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