Remote Grievance & Appeals Specialist
Banner Health
Banner Health is seeking a Grievance & Appeals Coordinator to manage the intake, review, investigation, and resolution of member grievances, appeals, and provider disputes. The role emphasizes high-volume processing, detailed documentation, and timely correspondence in a remote setting with Arizona residency required.
The incumbent will use CRM/IDX and regulatory knowledge to ensure accurate case handling, coordinate with internal teams and providers, and communicate effectively across multiple
#J-18808-Ljbffr$48.32k - $82.39k
...Responsible for reviewing, investigating and tracking member grievances and appeals, and provider claims disputes. Responsible for coordinating... ...time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be...Remote workHourly payFull timePart timeWork at officeFlexible hours- ...Managing the full life cycle of member and provider appeals and grievance cases, the full-time Appeals and Grievance Specialist will conduct case intake, investigation, and... ...to ensure timely resolution while working remotely. Key responsibilities Research and analyze case...Remote workFull timeWork at office
$60.78k
...Appeals and Grievances Specialist II Job Category: Customer Service Department: Appeals & Grievances Location: Los Angeles, CA, US, 900... ...requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in...Remote workFull timeLocal areaShift workWeekend work- ...outbound calls to members. Essential Job Duties • Serves as team lead for submission, intervention and resolution of appeals, grievances, and/or complaints from Molina members, providers and related outside agencies. • Trains new employees and provides...Remote workFull timeContract workWork at office
- Humana is seeking a Grievances and Appeals Representative 4 within the Internal Review Team to manage denials by reviewing clinical documentation... ...outcomes, while maintaining high productivity and strict confidentiality in a remote work setup. #J-18808-Ljbffr HumanaRemote 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 work
- ...Centers for 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...Hourly payContract workWork experience placementWork at office
$53 per hour
...Job Description Job Description REMOTE RN OPPORTUNITY – GRIEVANCE & APPEALS / UTILIZATION REVIEW $53/hour | 100% Remote | Long-Term Contract We're hiring experienced Registered Nurses to join a leading healthcare organization in a fully remote role! Position...Remote jobLong term contractWork from homeMonday to FridayShift workWeekday work- ...Job Description Job Description Description: 100% REMOTE CANDIDATES MUST LIVE IN ONE OF THE PREFFERED 15 STATES... ...Responsible for the comprehensive research and resolution of the appeals, dispute, grievances, and/or complaints from Client members, providers and...Remote workContract workLive inMonday to Friday
$20.39 - $34.71 per hour
...the documentation and processing of appeals, disputes and reconsiderations to ensure... ...timely. Key Details: This fully remote Appeals Specialist position is open to candidates anywhere... ...candidate has experience with appeals, grievances, claims, or other regulated casework...Remote workHourly payFull timePart timeWork at officeFlexible hours- MJHS in New York, NY seeks an A&G Coordinator to investigate and respond to member and provider appeals and grievances under CMS and DOH rules. In a non-clinical role, you will help ensure timely decisions and accurate documentation. You will determine the appropriate...
- CVS Health is hiring for an Appeals Specialist responsible for intake, investigation and resolution of appeals, complaints and grievances across products. The role requires coordinating responses from multiple units, identifying issue trends, and ensuring timely, accurate...
- CVS Health is seeking a detail-oriented professional to manage intake, investigation and resolution of appeals, complaints, and grievances across products. You will coordinate responses from multiple teams, identify trends, and propose solutions while ensuring timely, customer...
- CVS Health is seeking a dedicated Appeals Specialist to manage intake, investigation and resolution of member appeals and grievances. You will coordinate across clinical and operations units to deliver timely, accurate responses, identify trends, and propose solutions....
- ...denials, 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...
- ...seeking a Denials Management Follow Up Representative for a fully remote, full-time position in the United States. You will coordinate... ...for institutional and professional claims, monitor appeals, and analyze performance data to drive improvements. Work closely...Remote workFull time
$128k - $149.15k
...positive change in the field of mental healthcare. Rula is a remote-first company. We currently hire in most U.S. states, with... ...Hawaii. About the Role We are hiring a Psychiatric Complaints & Grievances Specialist to join our Psych Clinical Quality Team and strengthen the...Remote workFull timeLive inCurrently hiringHome office$44 - $56 per hour
...Job Description Job Description Grievance & Appeals Specialists Location: New York, NY (Hybrid/Onsite as applicable) Pay: $44.00 - $56.00 per hour Full-Time We are seeking experienced Grievance & Appeals Coordinators to support the intake, investigation...Hourly payFull timeWork at office$41.6k - $54.08k
...ongoing business needs. Impact you will make The Denials Appeals Specialist is responsible for analyzing, drafting, and submitting high-quality... ...in a productivity and quality metrics-driven environment Remote work experience in a structured environment Experience...Remote workPermanent employmentContract workFor contractorsWork experience placement- ...Supporting the documentation and processing of appeals, the full-time Appeals Specialist II will manage appeals, disputes, and reconsiderations to ensure... ...with state and NCQA requirements while working remotely. Key responsibilities Perform data entry to track, log...Remote workFull timeVisa sponsorshipWork visa
- ...Leveraging expertise in claims adjudication and risk management, the full-time remote Appeals Specialist will guide clients through the appeals process, ensuring compliance and fair decisions while collaborating with internal teams and mentoring staff. Key responsibilities...Remote workFull timeContract work
$52k - $79.04k
...Appeals Specialist | Tyson & Mendes Are you a detail-oriented billing professional who enjoys solving problems, navigating complex billing... ...policies, please refer to the document provided here . No recruiters/agencies #li-remote Pay Range $25—$38 USD...Remote workHourly payFull timeWork at office- CERiS, a division of CorVel Corporation, is seeking an Appeals Representative to handle provider inquiries and appeals via email, fax, telephone, or written correspondence. This is a remote role with strong emphasis on accuracy and timely processing in a compliant environment...Remote jobWork from home
$29.7 - $31.8 per hour
...between $29.70 - $31.80 based on experience. The Acute Coding Appeals Specialist integrates medical coding principles and objectivity in the... ...and improve patient and client experiences. This is a remote position; however, candidates must be willing and able to travel...Remote workTemporary workWork at officeLocal area- UT Southwestern Medical Center is seeking a Technical Denials Management Specialist II in the Revenue Cycle Department to review, research, and resolve claim denials and appeals for various insurers, while identifying payment trends to maximize collections. This WFH role...Remote jobWork at officeWork from home
$246.1k - $344.2k
...and reviews of medical records for appeals decisions. The Corporate Medical Director... ...or oversee clinical reviews of grievance and appeal cases for assigned... ...Neurology, and General Surgery clinical specialists Work Style Fully remote living in the USA. Occasional...Remote workFull timeTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to FridayWeekend work- ...Managing and coordinating grievance and appeals processes, the full-time Grievance & Appeals Coordinator will review incoming cases, ensure compliance... ...collaborate with internal teams while working in a hybrid remote environment. Key responsibilities Manage and coordinate...Remote workFull timeWork at office
- ...payers, hospital departments and patients. The role emphasizes appeals research, rebilling, and balance transfers to the next responsible... ...plans, and proficiency in Epic and Microsoft Office. This remote, US-based position supports a national network. #J-18808-Ljbffr...Remote jobWork at office
- Lumeris in the United States is seeking an Appeals Coordinator to review, research, and resolve appeals, ensuring compliance with CMS,... ...while maintaining confidentiality and high ethical standards. Remote role with weekends/holidays as needed; includes benefits and potential...Remote jobWeekend work
- MetLife’s Global Customer Service and Operations team seeks a Disability Appeal Specialist to review denied claims and perform holistic assessments under ERISA guidelines, focusing on accuracy and timely decisions. The role is virtual and nationwide, allowing collaboration...Remote job
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