Senior Clinical Appeals & Claims Lead
Superior Dental Care
Superior Dental Care, Inc. is seeking an experienced Senior Clinical Appeals Nurse to supervise staff and oversee medical claim reviews in a hybrid Ohio setting. The role emphasizes regulatory compliance, workflow optimization, and escalation management for complex cases. The ideal candidate holds a BSN, an Ohio RN license, and at least seven years in clinical appeals or health insurance, with demonstrated leadership experience. Join a team focused on accuracy, quality, and compliant practices. #J-18808-Ljbffr Superior Dental Care
- Medical Mutual in Ohio seeks a Senior Clinical Appeals Nurse to supervise clinical staff, review complex medical appeals, and ensure compliant utilization management. You will collaborate with physicians, providers, and internal teams to ensure appropriate and timely care...Suggested
- The MetroHealth System in Cleveland, OH is seeking a Registered Dietitian to oversee nutritional management and education for patients across divisions. Responsibilities include supervising diet technicians, dietetic interns, and dining service assistants; developing nutrition...Senior
- Applewood Centers is seeking a Supervising Psychologist to lead outpatient psychology services and supervise APA Interns and practicum... ..., psychotherapy, and staff development under administrative and clinical supervision. The role requires a doctoral degree in psychology,...SeniorFull time
- ...Appeals Specialist We are seeking a detail-oriented and experienced Appeals Specialist for our client in Middleburg Heights... ...this role, you will be responsible for managing insurance claim denials and leading the appeals process to secure appropriate reimbursement. The...ClaimsWork at officeRemote workMonday to Friday
- ...experience, including patient access, coding, Clinical Documentation Improvement (CDA), billing,... ...to synthesize complex issues, engage senior leaders, and drive consensusExposure to... ...machine learningStrong analytical skills in claims, productivity, access, and volume data to...SeniorClaimsApprenticeshipEasy work
$91.1k - $143.6k
...and operational documentation.Lead/participate in incident triage... ...interoperability features).Knowledge of X12 (claims/EDI) for revenue cycle... ...management in complex clinical environments. The wage range... ...From entry-level employees to senior leaders, we believe there’s always...SeniorClaims- A national company is seeking an experienced Workers' Compensation Claims Manager to lead the administration of their national workers' compensation program. The role involves overseeing a team, managing complex claims, and ensuring compliance with regulatory requirements...SeniorClaimsFlexible hours
- ...Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision. Includes the investigation... ...liability and damages, and the setting of proper reserves. Inc Manager, Senior, Claims, Workers Compensation, Technology, Insurance...SeniorClaims
- ...plans.ResponsibilitiesSupervises clinical and support staff evaluating medical claims and/or appeal cases and associated records to... ...which includes experience as a Senior Clinical Appeals Nurse or... ...insurance industryRelevant experience leading teams or projects (formally or...ClaimsCasual workWork at officeRemote work3 days per week
$80k - $85k
A leading risk and claims administration partner is seeking a Litigation Consultant to manage high-end cases involving serious injuries and complex legal inquiries. The role requires over 10 years of litigation experience and strong skills in communication, negotiation,...SeniorClaimsRemote work- ...information. Responsibilities Supervises clinical and support staff evaluating medical claims and/or appeal cases and associated records to... ...which includes experience as a Senior Clinical Appeals Nurse or... ...industry. Relevant experience leading teams or projects (formally or...ClaimsWork at office3 days per week
- Liner Legal is seeking a Hearing Paralegal to support SSDI and SSI claims at the Hearing, Appeals Council and Federal Court stages. The role focuses on case preparation, gathering evidence, and client support throughout the hearing process. You will work with attorneys...Claims
- ...Hospital Care Institute at the Cleveland Clinic is recruiting for senior and mid-career critical care... ...development to join an outstanding team in leading our enterprise to further transform... ...for payment or personal details claiming to come from reputable organizations...SeniorClaimsFull timePart timeLive inWorldwide
- ...~ We’ll help you create a provider profile that highlights your specialties and clinical approach, ensuring the right clients find you. ~ We handle credentialing, billing, claims, EHR, and tech support—so you can focus your time and energy on clinical work....ClaimsLive inWork at officeRemote work
- Sedgwick, Columbus or Dayton, Ohio, is seeking a Sr Adjuster/Marine Surveyor to investigate and adjust property and casualty claims with little to no supervision. The role requires examining policies, preparing cost estimates, interviewing claimants and witnesses, negotiating...SeniorClaims
- ...Insurance Company in Cleveland, OH is seeking an experienced Litigation Specialist to manage litigated and complex auto liability claims. You will handle claim investigations, determine coverage, draft reservations of rights, and coordinate with defense counsel to drive...SeniorClaims
- ...the United States is seeking an experienced attorney to provide legal support to U.S. HR and operations management with a focus on claims management and compliance. The role involves managing labor and employment-related claims, advising on policy updates, and supporting...SeniorClaims
- ...Ohio is seeking a Supervising Psychologist to oversee outpatient therapists and psychology interns. The position involves providing clinical supervision, conducting assessments, and ensuring quality care delivery in mental health services. Ideal candidates should have a...Senior
- A healthcare provider in Cleveland seeks a CDI Manager to oversee day-to-day operations of the Clinical Documentation Integrity program. The ideal applicant will possess a bachelor's degree and at least two years' experience in an acute care setting, along with excellent...Work at office
- Cleveland Clinic in Cleveland, Ohio, seeks a Section Head for the Ambulatory Neurology Clinic - Northeast Ohio (NEO) to lead clinical excellence and operational performance across the region. The position combines direct patient care with executive responsibility for a...
- A leading healthcare system in Cleveland, Ohio is looking for a Clinical Documentation Integrity Manager to oversee day-to-day operations of the CDI program. This role requires strong leadership skills, expertise in documentation integrity, and a commitment to ensuring...
- Cleveland Clinic is seeking a Section Head for the Ambulatory Neurology Clinic in Northeast Ohio to lead a large team of outpatient neurologists and advanced practice providers. This physician-leader will shape clinical practice, drive access, and ensure high-quality,...
- Cleveland Clinic is seeking an experienced Physician Assistant or Nurse Practitioner to co-lead the Trauma Service as APRN/PA Manager. Role is roughly 50% clinical and 50% administrative, including rounding in ICU/ED, central lines, chest tube placement and OR assistance...
$75k - $85k
...Inclusion Program Manager to oversee assessments and care plans for Inclusion and Intervention Classrooms. The role involves supervising clinical teams, ensuring compliance with ABA standards, and fostering a positive work environment. Candidates should have a Master's degree...Full time$110k - $160.91k
...transmission infrastructure is essential. This role is focused on leading and overseeing routing and siting efforts for electric... ...IsAs a Principal Consultant, Electric Transmission Line Siting Senior Lead, you will serve as a technical and strategic lead for both...SeniorFull timeFixed term contractCasual workWork at officeRemote workFlexible hoursShift work- ...Summary: The Senior Benefits Administrator is responsible for supporting the design, implementation, and administration of the companys... ...policies. Collaborate with third party administrator to process claims and communicate appropriate details with employees, leaders and...SeniorClaimsContract workWork experience placementWork visa
- ...seeking an Attorney Network Manager in Cleveland, OH. This role leads the Panel Management team to deliver high-quality legal services... ...our members, reporting to the Assistant VP of Attorney Network & Claims Management. The position combines strategic oversight with hands...Claims
- TechDigital Group is looking for a skilled individual to manage MarkLogic integration for the MLCOE project. You will lead the AEI Claims team, ensuring timely delivery of Marklogic deliverables and design improvements. Candidates should have 10-14 years of experience in...Claims
- ...Inc. in Cleveland, OH is seeking a Lab Associate III to support specimen processing, labeling, storage and testing activities in a clinical laboratory setting. The role requires preparing samples, assisting licensed personnel, maintaining reagents and equipment, and...Senior
$143.96k - $230.32k
Join Cleveland Clinic, where research and surgery are advanced, technology is leading-edge, patient care is world class and caregivers are family. Here, you will work... ...respected healthcare organizations in the world.The Senior Director of Pharmacy provides enterprise...SeniorLocal areaMonday to FridayShift work
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