Claims Appeals & Grievances Specialist
Molina Talent Acquisition
Molina Healthcare is seeking a claims & appeals specialist to support CMS-aligned processes in resolving member and provider concerns. You'll review medical records, assess denials, and communicate timely resolutions to stakeholders. Ideal candidates have 2+ years in managed care, strong customer service, and proficiency with claims systems and Microsoft Office. The role emphasizes regulatory adherence and cross-functional collaboration to meet deadlines. #J-18808-Ljbffr Molina Talent Acquisition
- JOB DESCRIPTION Job SummaryProvides support for claims activities including reviewing and resolving member and provider complaints... ...• Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and...ClaimsContract workWork at office
- ...investigate health plan denials and determine the appropriate action and resolution. Responsibilities include correcting claims, rebilling, and coordinating appeals with payors, while tracking outcomes and identifying denial patterns for process improvements. The role requires...Claims
$1,000 - $2,000 per month
...You'll Do: The Behavioral Health Specialist (BHS) manages and maintains the safety of... ...rights under DBHDS and DMAS regulations, grievance process, provides expectations, and... ...you receive a suspicious communication claiming to represent Connections Health Solutions...ClaimsHourly payFull timeTemporary workPart timeReliefImmediate startFlexible hoursShift workNight shiftWeekend work- ...• Participates in and maintains the integrity of the appeals process, both internally and externally. • Responsible... ...corrective actions. • Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. • Attends or...ClaimsWork at officeLocal area
- ...Medicare, Medicaid, HIPAA compliance, and a fast-paced environment. The position supports the revenue cycle team, handles mail, paper claims, audits, and month-end close tasks. It requires detail-orientation, proficiency with Excel/Word/Outlook, and a commitment to #J-18...ClaimsContract work
$128.06 per hour
...the world. Job Description ~ The Disaster Program Delivery Specialist: • Collects, coordinates and/or reviews applicant data to... ...needed throughout the program delivery process. • Supports the claims process by reviewing and validating damage details, scopes of work...ClaimsWork experience placementH1bImmediate startFlexible hours- ...focuses on managing FMLA, STD and LTD processes, serving as the primary client contact, and ensuring timely, accurate handling of claims. Ideal candidates will have an associate or bachelor’s degree, experience in employee benefits or related disciplines, and strong communication...Claims
- Nintendo in Redmond, WA is seeking a FP&A, Credits, Payments and Fraud analyst to analyze and process claims and manage credit/collections across Nintendo’s third‑party accounts. Minimum three years in dispute resolution is required; Oracle EBS and Microsoft Office proficiency...ClaimsFull timeWork at office
$19 - $23 per hour
...of this job with care before making an application. Intake Specialist (In-Office if Local / Remote if Non-Local) Our mission to change... ...; 10:00 am - 6:00 pm PST (occasional overtime depending on claim volume) Benefits: ~ Associates working 20+hrs per week: ~...ClaimsHourly payFull timeLive inWork at officeLocal areaRemote workMonday to Friday- Swedish Medical Group is seeking a skilled medical billing specialist to support spine and sports medicine services in the Bellevue area.... ...clinicians and billing staff to ensure accurate coding and timely claims, leveraging your clinic experience to maintain high-quality...Claims
- ...adjusting experience is required for career-entry applicants. Are you interested in building a career as an independent insurance claims adjuster? With continued storm activity and catastrophic weather events across the country, experienced and properly trained adjusters...ClaimsFlexible hours
- A leading training company in claims adjusting is seeking Independent Insurance Claims Adjusters in Kenmore, Washington. The role involves assisting individuals and businesses in recovering from disasters, with support and comprehensive training provided. This opportunity...ClaimsFlexible hours
- A leading claims adjusting firm in Bothell, Washington is seeking Independent Insurance Claims Adjusters to assist individuals and businesses in recovering from disasters. This role offers the chance for dynamic growth and the opportunity to make a real difference in people...Claims
$175k - $200k
...vague or dubious financial schemes, or promote roles that resemble get-rich-quick opportunities. If you receive a suspicious message claiming to be from Nexxen or encounter a questionable job posting associated with our name, please contact us at ****@*****.*** to...ClaimsFull timeWork at officeRemote work3 days per week$80 per hour
...-minutes) Guaranteed payment every two weeks via direct deposit Payment protection for no-shows, late cancellations, & denied claims Why Join Rula? Our dedicated therapist community is made up of thousands of providers across the country, each with diverse backgrounds...ClaimsHourly payFor contractorsPrivate practiceWork at officeRemote work$65k - $70k
...Description Summary Focus Partners is seeking a Referral Channel Specialist. This Specialist partners closely with Business Development... ...without reasonable accommodations, you may be barred from filing a claim under the provisions of the Workers’ Compensation Act of the...ClaimsWork experience placementInternshipWork at officeLocal areaRemote work2 days per week- ...Greet patients warmly and manage check-in/check-out Answer phones and respond to patient inquiries Verify and submit insurance claims and pre-authorizations Review EOBs and follow up on outstanding claims Schedule, reschedule, and confirm patient appointments...ClaimsFull time
$65k - $80k
...customer accounts and update information in the database. Assist customers with policy changes and inquiries. Process insurance claims and follow up with customers on claim status. Coordinate with underwriters to ensure timely policy issuance. Qualifications:...ClaimsFor contractorsWork at office$46.92k
Description: Located in Hershey, PA, Milton Hershey School (MHS) is a top-notch home and school where over 2,200 pre-K through 12th grade students from disadvantaged backgrounds are provided an extraordinary, cost-free, career-focused education. This is made possible ...Full timeWork from homeRelocation packageFlexible hoursWeekday work- ...specialize in defending against all types of General Liability claims. Our team is committed to effectively moving cases through the legal... ...claims handling through mediation, arbitration, trial, and appeal, we provide comprehensive legal representation tailored to the unique...ClaimsInterim roleRemote work
$24 per hour
...Job Description Job Description Specialist supports Friends of Youth’s mission by providing trauma-informed, strength-based, and youth-centered support to young adults residing in the Bridge Pointe Program. This 24/7 residential program serves young adults (ages 18...Hourly payFull timeWork experience placementWork at officeFlexible hoursShift work- ...— I’ve built this team around service, education, and long-term relationships. My background includes leadership, consulting, and claims, which gives our team a well-rounded understanding of how to properly protect families and support them when they need us most. We...ClaimsWork at officeRelocationRelocation packageFlexible hours
$19 - $22 per hour
...remind them to return. Resolve customer complaints and damage claims. Employee Supervision and Management The center manager... ...perform accurate monthly inventory counts Ensure cleanliness and appeal of entire site Maintain safe working environment Maintain...ClaimsHourly payLocal areaImmediate startFlexible hoursShift work$96k - $110k
...your ability to perform the essential functions of the job, with or without reasonable accommodations, you may be barred from filing a claim under the provisions of the Workers’ Compensation Act of the State of Rhode Island if the false information is directly related to...ClaimsWork at officeLocal areaRemote work2 days per week$132.8k - $219.1k
...Imagine loving what you do and where you do it. Job Category Claim, Legal Compensation Overview The annual base salary range... ...or the company and take cases from inception through trial and appeal. As a Senior Counsel with Travelers you will be responsible for...ClaimsWork at officeLocal areaFlexible hours$28.5 - $31 per hour
...A leading company in the construction materials industry is seeking a Prevailing Wage Specialist to join their team. This is a fantastic opportunity to work with a respected company that values accuracy, compliance, and collaboration. The ideal candidate will bring...Full timeLocal areaMonday to Friday- ...and employee-focused company that has been moving America's freight safely since 1920. Not all asset-based carriers can make the same claim. We know it's because we're committed to doing things the right way: supporting our drivers, investing in our equipment, and...ClaimsWeekly payTraineeship
$17.13 - $23.5 per hour
...schedule, facility, season, or specific work performed. Multiple premiums may apply if applicable criteria are met. The Parts Specialist will provide all retail and installer customers with a high level of service. This position will also support store management in...Hourly payMinimum wageLocal areaFlexible hours$48 - $53 per hour
Responsive recruiter Benefits: Employee discounts Flexible schedule Health insurance Opportunity for advancement Paid time off Training & development Wellness resources Bonus based on performance Registered Nurse...Hourly payFull timePart timeFlexible hoursWeekend workWeekday work$500 per month
...detail-oriented Business Office & Medical Billing Specialist to ensure efficient, accurate, and timely billing... ..., and spell‑of‑illness. Submit timely, coded claims to primary and secondary payers and aggressively appeal denials. Coordinate the month‑end "Triple Check"...ClaimsFull timePart timeWork at officeMonday to FridayFlexible hours
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Claims Appeals & Grievances Specialist. Be the first to apply!
- medical insurance claims specialist Bothell, WA
- remote medical claims processor Bothell, WA
- veterans claims Bothell, WA
- claims processing Bothell, WA
- medical claims auditor Bothell, WA
- dental claims analyst
- claims examiner ii
- insurance claims representative
- claims assistant workers compensation
- medical claims processor









