Remote Grievance & Appeals Specialist
Elevance Health
Elevance Health is seeking a Grievance/Appeals Representative I to work virtually full-time, handling grievances and appeals related to service and benefit coverage issues. The representative will conduct investigations, communicate with customers, and generate written correspondence regarding claims. Candidates should have a high school diploma and at least one year of experience in health insurance, preferably with customer service experience. Strong communication, organizational, and interpersonal skills are required. This role offers flexibility and aims to enhance work-life integration. #J-18808-Ljbffr
$14.9 - $29.06 per hour
...(CMS). Responsibilities Enters denials and requests for appeals into information system and prepares documentation for further... ...language for letters and prepares responses to member appeals and grievances. Elevates appropriate appeals to the next level for review....Remote workHourly payWork experience placementWork at officeWeekend 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
$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- ...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,... ...requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in...Remote workFull timeLocal areaShift workWeekend work- 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
- 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
$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$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$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
$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- ...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
- 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...
$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- 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
$95k - $115k
Western Health Advantage seeks an Appeals & Grievances Nurse (RN) for their Utilization Management team in Sacramento, CA. This full-time role offers a salary between $95,000 and $115,000 annually. The nurse will collaborate with various stakeholders to ensure compliance...Full time- A healthcare company is seeking a skilled Appeals Processor III to work remotely in the United States. This role involves reviewing and processing healthcare appeals related to Medicaid or Medicare coverage decisions. The ideal candidate will have at least 2 years of experience...Remote job
- A healthcare solutions company is seeking an Appeals Coordinator to support the Appeals Department with administrative tasks and manage... ...processing, and excellent analytical and communication skills. Remote work options are available along with competitive benefits...Remote job
- ...Denials Specialist Insight Global is seeking a fully remote Denials Specialist to support a Healthcare AI client. This is a part-time opportunity working... ...week where candidates will leverage their denials and appeals expertise to evaluate and improve AI-driven denial...Remote workContract workPart timeMonday to FridayFlexible hoursShift workWeekend work
- ...Hospital is searching for a Senior Denials Specialist for the comprehensive review, analysis,... ...of denied hospital claims through the appeals process. You'll work to ensure optimal reimbursement... ...work model to balance on-site and remote work. #J-18808-Ljbffr Tampa General...Remote work
- ...Senior Appeals Specialist Job Category: Medical Billing Full-Time Remote Location: Middleburg Heights, OH 44130, USA +1 more locations Description Key Responsibilities: Work as needed in all appeal worklists, potentially with a focus on contracted...Remote workFull time
$248.5k - $373k
UnitedHealth Group is looking for an Appeals and Grievances Medical Director to oversee clinical reviews and adjudications. This role offers the flexibility to work remotely from anywhere in the U.S. Key responsibilities include reviewing appeals cases, communicating with...Remote job$248.5k - $373k
UnitedHealth Group is seeking an Appeals And Grievances Medical Director. This role is crucial for the clinical review and adjudication of appeals... ...and grievances cases for UnitedHealthcare. You'll work remotely from anywhere within the U.S., collaborating closely with...Remote job$248.5k - $373k
UnitedHealth Group is seeking a Medical Director for Appeals and Grievances to oversee clinical reviews and adjudications from a remote location. Candidates must hold an MD or DO with board certification, alongside significant clinical and Quality Management experience...Remote job$248.5k - $373k
A healthcare organization is seeking a Medical Director for Appeals and Grievances to oversee ongoing clinical reviews and adjudications. This... ...provisions and liaising with medical directors. The position offers remote work flexibility and a comprehensive benefits package....Remote job- Texas Health Institute is seeking an Appeals and Grievances Medical Director who will be responsible for the clinical review and adjudication... ...of appeals cases. This role offers the flexibility to work remotely from anywhere within the U.S. It involves communicating with...Remote job
- A staffing solutions company is seeking a Grievance & Appeals Coordinator for a fully remote position in Detroit, MI. This role involves processing appeals, grievances, and inquiries while maintaining accurate documentation and effective communication. The ideal candidate...Remote jobContract work
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