Remote Grievance & Appeals Specialist
Elevance Health
Elevance Health in Tampa, Florida seeks a Grievance/Appeals Representative I to manage customer claims and ensure resolution of grievances. This role primarily involves analyzing and processing claims, with a significant focus on communication and documentation. The ideal candidate will possess a high school diploma and at least one year of experience in health insurance or customer service. Strong verbal and written communication skills, organizational abilities, and PC proficiency are preferred. This is a virtual position with flexible work arrangements. #J-18808-Ljbffr
- ...Elevance Health is seeking a Grievance/Appeals Representative I to work virtually from Grand Prairie, Texas. This position involves investigating customer grievances and appeals related to service coverage while managing communications with customers and regulatory agencies...Remote work
- ...Geisinger is seeking a dedicated professional to support the administration of the Appeals and Grievance process. The role involves acting as a liaison between members and the Plan regarding denied claims, services, and other concerns. Responsibilities include managing...Remote work
- ...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, ensuring compliance with various health regulations, and preparing reports. Requirements include at least 2 years...Remote workFull time
$60.78k
...Appeals And Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position... ...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...Remote workHourly payFull timeContract workWork experience placementWork at office- ...employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the... ...resolving and responding to requests for member and provider appeals, grievances, reconsiderations and corrected claims for all lines of business...Remote workFull timeContract workWork experience placementWork at officeLocal area1 day per week
- Geisinger is looking for a professional to provide support in the administration of the Appeals and Grievance process. This role involves liaising between members and the plan to address denied claims and benefit issues. Applicants should have a minimum of 5 years of relevant...Remote job
- Firstsource Solutions Limited is seeking a full-time hourly Remote Customer Service Representative in the United States. The role involves reviewing grievance and appeals documents, classifying disputes, and managing member information in line with HIPAA regulations. The...Remote jobHourly payFull time
- Blue Cross Blue Shield of Arizona is seeking a skilled professional for a clinical role addressing provider appeals and grievances. This position demands expertise in managed care while ensuring compliance with privacy regulations. The ideal candidate will possess a relevant...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 job
- ...Member And Provider Complaint Resolution Specialist 100% remote candidates must live in one of the preferred 15 states (AZ, FL, GA... ...for the comprehensive research and resolution of the appeals, dispute, grievances, and/or complaints from Molina members, providers and...Remote workContract workLive inMonday to Friday
$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$45.9k - $78.6k
...a community of connected care, where coordinated, quality service is the norm and every member feels valued. Medica’s Appeals and Grievance Specialist plays a vital role in ensuring our members and providers receive clear, timely, and accurate resolutions to their concerns...Work experience placementWork at office3 days per week$50k - $55k
...Appeals Coordinator Level II At MedReview, our mission is to bring... ...the department. The Appeals Specialist level II performs research,... ...investigation, and analysis of appeals, grievances, and other types of... ...frequent interruptions Remote Work Requirements: High speed...Remote work- ..., 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 Medicare...
- ...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...
$18.33 per hour
...Mateo NE Albuquerque, NM 87113-2237 Compensation Pay Range: Minimum Offer $18.33 Maximum Offer $27.25 Now Hiring: Appeals and Grievance Specialist Summary: Build your Career. Make a Difference. Presbyterian is hiring a skilled Appeals and Grievance Specialist...Full timeTemporary workLocal areaImmediate startShift work- Sagility is seeking an Appeals and Grievance Coordinator who will manage and resolve member and provider complaints while adhering to regulatory requirements. This role involves conducting investigations, documenting actions, and ensuring compliance. As a key contact for...Remote jobWork from home
$24 - $24.5 per hour
Fallon Health in Worcester, MA is hiring a Healthcare Triage Administrator. This position supports the Appeals and Grievances process, handling member and provider interactions while ensuring compliance with regulatory standards. The ideal candidate will have a high school...Hourly pay$45.9k - $68.78k
Medica Services Company LLC in Minnetonka is looking for an Appeals and Grievance Specialist to manage member concerns and ensure timely resolutions. The role requires a high school diploma, strong analytical skills, and up to 5 years of experience in healthcare operations...3 days per week- ...TeamHEALTH is looking for a Denials and Appeals Representative to handle denials and appeals for patient accounts in a cooperative team environment. The ideal candidate has at least two years of experience with insurance denial processes. Responsibilities include processing...Remote work
- Blue Cross Blue Shield of Arizona seeks a Clinical Appeals Specialist to utilize their clinical acumen for resolving member and provider appeals, grievances, and claims. The role requires a minimum of 1 year of healthcare-related experience and an Associate's Degree in...
$19 - $21 per hour
...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 workHourly pay- ...Pride Health is seeking a Grievances and Appeals Nurse for a remote contract position. This role is vital in investigating and resolving grievances and appeals efficiently for a well-known client. Responsibilities include acting as a subject matter expert, ensuring compliance...Remote workContract work
$19.5 - $21 per hour
...Description We are seeking a detail-oriented and experienced Appeals Specialist for our client in Middleburg Heights, Ohio. In this role, you... ...-$21.00 ~ Monday-Friday 8am-5pm ~3 months in office then remote ~ Benefits offered Key Responsibilities Review...Remote workWork at officeImmediate startMonday to Friday- ...Review & Appeals Specialist I Applicants must be authorized to work lawfully in the United... ...employees in hybrid positions work both remotely and onsite in the NCCPA headquarters based... ...in business, healthcare, appeals and grievances, state medical board, legal, or...Remote workWork at office
$24 - $25 per hour
...States and we are currently looking to add a Revenue Cycle Appeals & Recovery Specialist to join our fast-paced and energetic team. The ideal... ...professional environment, apply today! This role is full time, remote with a base rate of $24 to $25 per hour and a full benefit...Remote workHourly payFull timeLive inShift work- 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 jobWork from homeFlexible hours
$248.5k - $373k
...Appeals And Grievances Medical Director At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities... .... Work at home! You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges...Remote workMinimum wageWork experience placementLocal areaWork from home$248.5k - $373k
...together . Work at home! You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: The Appeals and Grievances Medical Director is responsible for ongoing clinical review and...Remote workMinimum wageWork experience placementLocal areaWork from home
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