Appeals & Grievance Resolution Specialist
CVS
CVS Health is seeking an Appeals/Grievances Specialist to manage intake, investigation, and resolution of appeals, complaints, and grievances for all products. The role requires coordination across business units, analysis of benefit language, and timely, customer-focused responses to members and providers. Responsibilities include researching plan design or coverage, validating claim processing logic, triaging components to SMEs, and serving as a technical resource for related issues. #J-18808-Ljbffr CVS Health
- ...resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with... ...team lead for submission, intervention and resolution of appeals, grievances, and/or complaints from Molina members, providers and related...SuggestedRemote jobContract workWork at office
- HealthFirst is seeking a Grievance Specialist for the 100% remote Appeals & Grievances team. You will manage member grievances end-to-end, investigate with... ...-functional partners, and ensure timely, compliant resolutions within regulatory standards. The role emphasizes...SuggestedRemote job
- CVS Health in the United States is seeking an Appeals, Complaints and Grievances Specialist to manage intake, investigation and resolution for all products, coordinating with multiple business units to ensure timely, customer-focused responses. You will research benefit...Suggested
- 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
- 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
$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... ...teams to gather required information and support case resolution Maintain clear and professional communication throughout the...Contract workWork at officeLocal areaImmediate startRemote work$58.9k - $80.07k
The Grievance Specialist is a member of the Appeals & Grievances (A&G) team at Healthfirst and is responsible for managing and resolving member or authorized... ...role focused exclusively on grievance and complaint resolution. The Specialist plays a key role in advocating for...Remote jobContract workTemporary workWork experience placementWork at office$17 - $28.46 per hour
...to simplify health care one person, one family and one community at a time. Position Summary Review, research, and enter grievance and appeal cases within one business day of receipt. Monitor multiple intake sources, including call tracking, fax, email, and mail, and...Hourly payFull timeLocal area- Ventra Health, Inc. is seeking a Coding Denial Specialist to investigate and resolve health plan denials, manage... ..., and ensure accurate coding. You will generate appeals and follow payer guidelines for timely resolution of issues. Requirements include a high school diploma...
$30 per hour
Hybrid-Appeals Specialist needed for a contract opportunity with Yoh's client located in Philadelphia, PA. Schedule: Tuesday-Wednesday-Thursday... .... Medicare experience Utilization Management or Appeals/Grievances experience preferred. Working knowledge of plan products,...Contract work$20.39 - $34.71 per hour
...Supports the documentation and processing of appeals, disputes and reconsiderations to ensure... ...Key Details: This fully remote Appeals Specialist position is open to candidates anywhere... ...candidate has experience with appeals, grievances, claims, or other regulated casework and...Hourly payFull timePart timeWork at officeRemote workFlexible hours- .... You will coordinate follow-up with third-party payors to secure reimbursement for institutional and professional claims, monitor appeals, and analyze performance data to drive improvements. Work closely with revenue integrity teams to streamline denial processes, ensure...Full timeRemote work
$51k - $74.88k
...The Appeals & Grievances (A&G) unit processes member and non-contracted provider appeals for all... ...Medicare and complete care. Appeals Specialist is the subject matter expert responsible... ...-clinical case development and case resolution while ensuring compliance with...Full timeTemporary workWork experience placementRemote work- Lumeris is seeking an Appeals Coordinator for a remote, United States-based role. You will review, research, and resolve appeals, ensuring compliance with regulations and deadlines. You will handle documentation, communications with members and providers, and prepare case...Remote job
- REVCO SOLUTIONS INC. is seeking an experienced MVA/TPL Resolution Specialist II to independently investigate, negotiate, and resolve complex hospital accounts involving Motor Vehicle Accident and Third-Party Liability claims. You will work with insurers, attorneys, patients...Remote job
- Connections Health Solutions is seeking an Accounts Resolution Specialist to ensure proper billing and reimbursement across our remote team. You will work with insurance companies to expedite payments and manage denials, leveraging WAYSTAR and Avatar for documentation....Remote jobWork at office
- ...II to review and resolve complex claim denials by coordinating with payers, hospital departments and patients. The role emphasizes appeals research, rebilling, and balance transfers to the next responsible party. Ideal candidates have 3+ years in hospital revenue cycle,...Remote jobWork at office
- 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
- Centene Corporation is seeking an Appeals Specialist to support the documentation and processing of appeals, disputes and reconsiderations to meet NCQA requirements. This fully remote role is open to candidates anywhere in the U.S. and follows Eastern Time hours (8:30...Remote job
- Mutual of Omaha Insurance Co. is seeking an Appeals Specialist to adjudicate complex disability and life claim appeals from a remote location within the United States. The role emphasizes risk management, contract interpretation, and collaboration with the Law Division...Remote jobContract work
$82.65k - $91.83k
Appeals Specialist If you're looking for a fulfilling career that can make a real difference in your life, and the lives of others, you've come to the right place. As a national health solutions partner, we put people first in everything we do — and that begins with our...Contract workFlexible hours- Lumeris in the United States is seeking an Appeals Coordinator to review, research, and resolve appeals, ensuring compliance with CMS, NCQA, and internal timelines. You will prepare written responses, track documents, and escalate complex appeals as needed while maintaining...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
- Remote Overview: Respond to all assigned levels of denials by submitting appeal letters and required documentation to insurance companies within the appeal filing time limits. Submit external review requests and required documentation to the state within the filing time...Remote work
- IVX Health is seeking a Prior Authorization Appeals Specialist to resolve complex pre-service denials and appeals. You will work with providers, payers, and internal teams to navigate payer requirements and assemble supporting documentation for timely reconsiderations....Remote job
- Harper is seeking a dedicated specialist to resolve complex customer issues spanning payments, disputes, cancellations, audits, and insurance... ...questions. You will own cases from discovery to documented resolution, coordinating across systems and with customers via phone to...Relocation
- ...accurate documentation and timely processing. Responsibilities include monitoring cases, following up with insurers, and preparing appeals for denials. Ideal candidates have experience with ICD-10 and CPT coding, excellent organizational skills, and #J-18808-Ljbffr Jobgether
- 100Plus is seeking an RCM Specialist to manage the full lifecycle of medical claims, from pre-service authorizations to post-submission... ...in handling 835 remittances, payer denials, and A/R through to resolution, while maintaining compliance with HIPAA and industry...
$64.5k - $67k
...Here, making a real difference isn’t just a goal - it’s what we do, one conversation at a time. The Opportunity The Disability Appeal Specialist is responsible for reviewing denied claims and complete a fair, independent assessment and a thorough holistic review of the...Contract workTemporary workWork at officeLocal areaWorldwide- ...point of contact for complex member issues, including health plan grievances, RD grievances, and advanced member account support and food... ...benefit issues Ensure timely, compliant, and well-documented resolution of all escalations Communicate professionally and clearly with...Flexible hours
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