Senior Appeals & Grievances Specialist (Hybrid Remote)
L.A. Care Health Plan
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 in Managed Care, knowledge of medical terminology, and excellent communication skills. This full-time position offers a hybrid work schedule and a comprehensive benefits package including medical, dental, vision, and PTO. #J-18808-Ljbffr
- ...health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability,... ...are classified as hybrid, onsite or remote. While the majority of our employees... ...responding to requests for member and provider appeals, grievances, reconsiderations and corrected claims...Remote workFull timeContract workWork experience placementWork at officeLocal area1 day per week
$60.78k
Appeals and Grievances Specialist II Job Category: Customer Service Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition... ...position requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in...Remote workFull timeLocal areaShift workWeekend work- ...General Hospital is searching for a Senior Denials Specialist for the comprehensive review,... ...hospital claims through the appeals process. You'll work to ensure... ...new staff. The position offers a hybrid work model to balance on-site and remote work. #J-18808-Ljbffr Tampa...Remote workSenior
- ...Branch is seeking a Sr. Patient Account Specialist. This role involves billing all third-party payers and managing appeal processes for denied claims. The... ...ability to train team members. This is a hybrid position, offering a mix of remote and on-site work in Galveston, Texas...Remote workSenior
$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- ...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 workContract workWork at office
$95k - $115k
Western Health Advantage seeks an Appeals & Grievances Nurse (RN) for their Utilization Management team in Sacramento, CA. This full-time role... ...3 years of relevant experience. The position allows some hybrid work. Join us to impact healthcare quality and accessibility...Full time- 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 job
- 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
$84k - $126k
Elevance Health is seeking a dedicated professional to investigate member and provider grievances and appeals. This role requires strong problem-solving skills and at least four years of experience in a managed care or healthcare setting, along with a relevant master's...Remote jobSenior- 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
- Elevance Health is seeking a qualified professional for a role in grievance investigations and appeals handling in Denver, Colorado. The position requires a minimum of four years of experience in a managed care or healthcare setting and a current active unrestricted license...Remote jobSenior
- SHPCA SCAN Health Plan is seeking a Grievances and Appeals Senior Coordinator to support team supervisors and manage member grievances. The role includes... ...communication skills. This position offers mostly remote work, an annual bonus program, generous PTO, and a robust...Remote jobSenior
$21.78 - $31.52 per hour
Join Scan-Health-Plan as a Grievances and Appeals Senior Coordinator in Lakewood, California. In this role, you will investigate member grievances... ...problem-solving skills. Scan-Health-Plan offers a mostly remote work environment with competitive pay ranging from $21.78...Remote jobSeniorHourly pay- FNBO is seeking an Instant Issuance Senior Specialist in Omaha who will oversee card inventory and printer logistics, and provide... ...and good problem-solving skills. Work environment is hybrid, with flexibility for remote days, ensuring collaboration and productivity. #J-188...Remote jobSenior
- PowerToFly seeks a Senior Request for Proposal Specialist based in Seattle. This role involves managing RFPs and working... ...superior communication skills. This is a hybrid role, requiring some in-office presence alongside remote work opportunities. #J-18808-Ljbffr PowerToFlyRemote workSeniorWork at office
- ...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 workSeniorFull time
- Southern California Edison is seeking a Permitting Senior Specialist to join their team in Redlands, California. In this... ...regulations, and managing project timelines. The position is hybrid, allowing for both in-office and remote work. Ideal candidates should have at least five...Remote workSeniorWork at office
- 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 jobSeniorWork from homeFlexible hours
- ...Southern California Edison (SCE) as a Land Management, Senior Specialist in Pomona, California. In this role, you will... ...estate transactions. This position requires traveling and offers a hybrid work mode, combining office and remote work. #J-18808-Ljbffr EdisonrefertalentRemote workSeniorWork at office
- Edisonrefertalent is seeking a Sourcing Senior Specialist to join their team in Pomona, California. In this vital... ...ideally possess a relevant Bachelor's degree. This hybrid position allows for a combination of in-office and remote work. #J-18808-Ljbffr EdisonrefertalentRemote workSeniorContract workWork at office
- 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
- ...communication skills, with extensive experience in watershed-scale planning and hydraulic modeling. This position offers a hybrid schedule allowing up to 40% remote work, along with comprehensive benefits including paid overtime and an annual performance bonus. A Bachelor’s...Remote jobSenior
- ...Forman in Louisville, Kentucky is seeking a Senior People Systems Specialist with expertise in Workday integrations.... ...analytical skills. The position includes a hybrid working model, with 4 days in-office and Fridays available for remote work. #J-18808-Ljbffr Brown-FormanRemote jobSeniorWork at office
- Qiagen N.V is looking for a Senior Sales Application Specialist for HID & Forensics in Germantown, MD, responsible for providing tailored HID solutions... ..., including key laboratory techniques. Qiagen offers a hybrid work model and comprehensive benefits. #J-18808-Ljbffr...Remote jobSeniorFull time
- L.A. Care Health Plan is seeking an Appeals and Grievances Nurse Specialist RN II to assist members with health care access and benefit coordination... ...RN role and a nursing degree. This position offers a hybrid remote schedule and includes various benefits such as Paid Time...Remote job
- The Robert Joseph Group is seeking a Senior GL Accountant to join their team in Maryland. This role offers a hybrid work environment combining remote and in-office work, providing flexibility and work-life balance. As a Senior GL Accountant, you will be responsible for...Remote workSeniorWork at office
- ...Media Agency in Dallas is seeking a full-time Senior Public Relations Specialist. The ideal candidate will have 4-5 years of... .... The position offers competitive pay, benefits, and a hybrid work schedule allowing for both office and remote work. #J-18808-Ljbffr ChampionmgtRemote workSeniorFull timeWork at office
- ...Senior Proposal Specialist - Hybrid, Columbia, SC BlueCross BlueShield of South Carolina Job Posting Apr. 27, 2026 Job Description Summary This high... ...environment. The position is hybrid, 3 days in office, 2 days remote. You will work an 8-hour shift scheduled during our...Remote workSeniorFull timeWork experience placementSecond jobWork at officeMonday to FridayShift work
- Elios AI is seeking a Senior Endur Specialist in Houston, TX for a full-time position. This role includes configuring Openlink Endur... ...market experience is crucial for success. The role offers a hybrid work model, balancing remote and onsite tasks. #J-18808-Ljbffr Elios AIRemote workSeniorFull time
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Senior Appeals & Grievances Specialist (Hybrid Remote). Be the first to apply!
- mental health specialist Los Angeles, CA
- cash reconciliation specialist Los Angeles, CA
- instructional technology specialist Los Angeles, CA
- channel specialist Los Angeles, CA
- privacy specialist Los Angeles, CA
- assessment specialist Los Angeles, CA
- asset protection specialist Los Angeles, CA
- sourcing specialist Los Angeles, CA
- program specialist Los Angeles, CA
- title specialist Los Angeles, CA

