Remote Appeals & Grievance Specialist
Wellsense-Health-Plan
- Remote job
WellSense Health Plan is seeking a dedicated Appeals and Grievance Specialist to oversee member appeal processes and manage grievances effectively. This full-time remote role requires experience in managed care and Medicare, as well as strong problem-solving and communication skills. As part of a dynamic team, you'll ensure compliance with regulatory standards and provide high-quality support to our diverse membership. Competitive salaries and excellent benefits packages enhance your career with WellSense. #J-18808-Ljbffr Wellsense-Health-Plan
$14.9 - $29.06 per hour
...Services (CMS). Responsibilities Enters denials and requests for appeals into information system and prepares documentation for further... ...for letters and prepares responses to member appeals and grievances. Elevates appropriate appeals to the next level for review. Generates...Remote jobHourly payWork experience placementWork at officeWeekend work- 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...Remote jobFull time
- ...employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the... ...resolving and responding to requests for member and provider appeals, grievances, reconsiderations and corrected claims for all lines of business...Remote workFull timeContract workWork experience placementWork at officeLocal area1 day per week
$21.16 - $38.37 per hour
Join to apply for the Medicare Appeals & Grievances Specialist (PST Hours) role at Molina Healthcare . This position is remote and will be working Pacific Standard hours. Highly Qualified Candidates Will Have The Following Experience Strong understanding of UM, Appeals...Remote workHourly payFull timeContract workWork experience placementWork at office$60.78k
Appeals and Grievances Specialist II Job Category: Customer Service Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID:... ...requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in...Remote workFull timeLocal areaShift workWeekend work- L.A. Care Health Plan is hiring an Appeals and Grievances Nurse Specialist RN II in Los Angeles. This role involves assisting members with healthcare access issues and resolving complaints in compliance with regulatory standards. The ideal candidate must have an Associate...Remote 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 job
- ...Member Complaint Resolution Specialist This position is for five locations. Candidates must live in one of the preferred... ...Responsible for the comprehensive research and resolution of the appeals, dispute, grievances, and/or complaints from Molina members, providers and...Remote workContract workLive inMonday to Friday
$21.16 - $38.37 per hour
A healthcare provider is seeking a Medicare Appeals & Grievances Specialist to handle member appeals and grievances. This remote position requires strong experience in managed care, particularly with Medicare regulations. Ideal candidates will have excellent attention...Remote jobHourly payWork at office- ...Member Appeals Specialist The role we are looking to fill would be focused on handling standard member appeals for pre-service pharmacy... ...standard appeals). The job requires use of our Appeals and Grievances system called Jiva (WellSense UM and CM are also working in...Remote workTraineeship
$50k - $55k
.... Under the direction of the Appeals Department leaders, the Appeals... ...the department. The Appeals Specialist level II performs research,... ...investigation, and analysis of appeals, grievances, and other types of... ...atmosphere of frequent interruptions Remote Work Requirements High speed...Remote work- BroadPath is looking for a Work from Home Appeals and Grievance Specialist to support members with their benefits, specifically appeals and grievance... ...strong customer service skills. This position offers a remote work opportunity and requires effective verbal communication...Remote jobWork from home
$19 - $20 per hour
...Position: Grievance & Appeals Specialist Compensation: $19-$20 /hour, depending on experience Location: Tulsa, Oklahoma Inceed has partnered with a great company to help find a skilled Grievance & Appeals Specialist to join their team! Step into a dynamic...Weekly payPermanent employmentWork at officeMonday to Friday$48.6k - $83.16k
...Position Responsible for processing expedited appeals: those that are complex in nature,... ...times of the Expedited Appeal unit, the Specialists are required to work weekends and holidays... ...versed in all aspects of the complaint, grievance and appeal process and be able to...Remote jobHourly payContract workWeekend work$65k - $88.6k
Humana is seeking a Senior Grievances & Appeals Analyst to analyze and audit complaints, ensuring the integrity of claims and authorization processes. This role involves utilizing data analysis tools and performing root cause analysis of audit findings to recommend improvements...Remote jobWork from homeFlexible hours- Education LevelAssociates Degree## DescriptionThe Grievance and Appeals Specialist is responsible for handling member and provider grievances, complaints, appeals and provider claim disputes across all product lines. This role ensures compliance with contractual and regulatory...Work experience placementWork at officeFlexible hoursAfternoon shift
- A healthcare organization in Rhode Island is seeking a Grievance and Appeals Specialist to manage member and provider grievances, complaints, and appeals across all product lines. The role involves ensuring compliance with regulatory standards and maintaining documentation...Work at office
- Blue Cross Blue Shield of Arizona seeks a Clinical Appeals Specialist to utilize their clinical acumen for resolving member and provider appeals, grievances, and claims. The role requires a minimum of 1 year of healthcare-related experience and an Associate's Degree in...
- ...Position Grievance and Appeals Coordinator Position Description Join our clients dynamic team as a vital link in thier Grievance and Appeals department, where you will play a crucial role in ensuring our members and providers receive the highest standard...Remote workWork at officeImmediate startWork from home
- ...up actions as advised Research claim variances in hospital patient accounting systems (EPIC, Meditech, Cerner, Athena) Draft appeals to insurance carriers on denied or underpaid claims Review claim detail including coding, billing and insurance information for...Remote workPermanent employmentWork from homeFlexible hours
- ...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 workFull time
$74.8k - $78.7k
...Carolina); Omaha, NE (Nebraska); Work from Home Work Arrangement: Remote : Work at home employee residing outside of a commutable... ...opportunity. Requisition #: 76084 The Role at a Glance As an Appeals Specialist you will be responsible for being a product subject matter expert...Remote workContract workTemporary workWork experience placementWork at officeWork from homeRelocation package- A healthcare company is seeking a skilled Appeals Processor III to work remotely in the United States. This role involves reviewing and processing healthcare appeals related to Medicaid or Medicare coverage decisions. The ideal candidate will have at least 2 years of experience...Remote job
- ...Specialist, Appeals Claims As an Appeals Specialist you will be responsible for being a product subject matter expert to provide full, fair appeal reviews for multiple product lines. You will perform and deliver on appeals claims assignments/projects while simultaneously...Remote workContract workTemporary workWork experience placementWork at office
$51k - $80.07k
Healthfirst is seeking a Grievance Specialist to manage and resolve member grievances across its product lines, focusing on regulatory compliance... ...salary, with salaries ranging from $51,000 to $80,070 based on location and experience. #J-18808-Ljbffr Remote JobsRemote work$27.74 - $39.16 per hour
...Coding Denial And Appeals Specialist The Coding Denial and Appeals Specialist is responsible for ensuring that workflows, processes, and... ...hours per two-week pay period Monday-Friday Business Hours Remote work setting, but must live in the state of Minnesota...Remote workHourly payFull timeLive inMonday to FridayFlexible hoursShift work- CGS Administrators LLC is hiring an Appeals Specialist in Nashville, TN. The role involves performing non-medical reviews, processing redetermination letters, and preparing documentation for legal inquiries. Candidates should have a High School Diploma and 2 years of relevant...Remote jobWork at office
- TeamHEALTH is looking for a Denials and Appeals Representative to handle denials and appeals for patient accounts in a cooperative team environment. The ideal candidate has at least two years of experience with insurance denial processes. Responsibilities include processing...Remote job
- Aspirion in Delray Beach, Florida, is looking for a Denials Appeals Specialist to analyze and submit appeals for denied claims. The role supports... ...bachelor’s degree preferred. The position involves working remotely and understanding healthcare operations. #J-18808-Ljbffr...Remote job
- A healthcare solutions company is seeking an Appeals Coordinator to support the Appeals Department with administrative tasks and manage... ...processing, and excellent analytical and communication skills. Remote work options are available along with competitive benefits...Remote job
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