Member Appeals & Grievances Specialist
Metropolitan Jewish Health System, Inc.
The Metropolitan Jewish Health System, Inc. is seeking a coordinator to investigate and respond to written or verbal appeals and grievances from members and providers, ensuring adherence to CMS, DOH, and contract requirements. You will determine service type, manage timelines, and document cases for review. The role requires strong communication, attention to detail, and the ability to manage multiple tasks while meeting strict deadlines, with preferred an associate degree and 2 years of related #J-18808-Ljbffr Metropolitan Jewish Health System, Inc.
- 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...Suggested
$14.76 - $31.97 per hour
...support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to... ...Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related...SuggestedRemote jobHourly payContract workWork experience placementWork at office- At Molina Healthcare, the Claims Appeals Specialist provides support for handling member and provider complaints, aligning with CMS standards and regulatory... ...researching and resolving appeals, disputes, and grievances with timely communications to authorized representatives...Suggested
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Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin... ...service is the norm and every member feels valued. The Appeals & Grievances Specialist III role manages and resolves member complaints,...SuggestedWork experience placementRemote work- 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...SuggestedRemote work
- Point32Health, Inc. is seeking an Appeals and Grievance Coordinator to manage day-to-day tasks within the A&G department. You will process mail, assign cases, and support analysts while ensuring compliance with regulatory timelines. The role requires 1-2 years of relevant...Remote jobWork from home
$22 - $23 per hour
...Immediate need for a Grievance & Appeals Coordinator . This is a 12+ Month Contract opportunity with long-term potential and is US ( Remote... ...location). Key Responsibilities Review, process, and resolve member appeals and grievance cases in accordance with company policies...Contract workWork at officeLocal areaImmediate startRemote work$48.37k - $72.56k
...Candidates must be willing to work weekends. The CTM Coordinator, Appeals & Grievances manages the day-to-day intake, investigation tracking, and... ...of all cases, coordinating across departments to ensure member issues are addressed efficiently and correctly primarily for...Remote job$40k - $46k
About: Own and resolve high-priority, complex, or sensitive member escalations end-to-end. Own all escalations and grievances relating to RDs end-to-end and collaborate with the Clinical Operations team. Investigate RD reports of member behavior and safety concerns....Remote workFlexible hours$26.99 per hour
We are currently seeking experienced Appeals & Grievances Specialists! This is a full remote opportunity paying $27/hr. The ideal candidate has experience investigating and responding in writing to internal and regulatory complaints. Experience in ACA is a plus. If...Hourly payPermanent employmentTemporary workWork experience placementRemote workShift work- Foodsmart is seeking a remote Member Support Specialist, Escalations & Grievances to resolve complex, high-priority member issues with empathy and precision. You will coordinate with health plans, RDs, and internal teams, guiding sensitive cases to timely, compliant resolutions...Remote job
- Healthfirst is seeking an Appeals & Grievances Weekend Inventory Manager to oversee weekend appeal operations and staffing. This full-time role requires coordinating with leaders to maintain compliant, high-quality output during Fri-Mon or Thurs-Sun shifts. The ideal candidate...Full timeShift workWeekend work
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$51k - $74.88k
...The Appeals & Grievances (A&G) unit processes member and non-contracted provider appeals for all of HFs line of businesses which include commercial Medicaid... ...enrollments Medicare and complete care. Appeals Specialist is the subject matter expert responsible for non-clinical...Full timeTemporary workWork experience placementRemote work- ...Rockland Federal Credit Union is seeking friendly, service-focused individuals for the Member Solutions Center in a remote, full-time role. The position offers an hourly salary of $20.00–$22.00, with weekday shifts and alternating Saturday hours. You will handle member...Hourly payFull timeRemote workShift workWeekday work
$28 - $34 per hour
...at Akidolabs.com. Position Summary The Grievance Coordinator is responsible for the management... ...all health plan grievances, complaints, appeals support, and regulatory inquiries for... ...health plan grievances, complaints, and member concerns received across the region....Hourly payWork at office- Travel With Sann is seeking a friendly, professional Member Experience Associate to join our team in a fully remote capacity. You will serve as the primary point of contact for members, answering questions, resolving concerns, and guiding them through the customer journey...Remote job
$17 - $25 per hour
...Position Summary What you'll do... Provides member service. Maintains the checkout area. Resolves member issues and concerns. Promotes Sam's Club products and services. Provides guidance and support to members regarding self-service technology. Processes member purchases...Hourly payMinimum wageFull timeTemporary workPart time- Aspirion is seeking a Denials Appeals Specialist to analyze denial reasons, draft and submit appeals, and support improved cash flow. You will work with carriers and internal teams to resolve claims and minimize revenue leakage. Ideal candidates bring strong analytical...Remote job
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- RadiFi Credit Union is seeking a Member Success Advocate I to serve as a resource within the branch network for new and existing member accounts, along with teller transactions. You will promote, refer, and cross-sell through a consultative needs-based approach, handling...Remote job
- ...remote role in the United States. The position entails handling inbound and outbound calls, emails, and information intake to match members with appropriate legal representation. You will work in a team environment within a call center setting, maintaining KPI metrics...Remote job
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