Remote Senior Appeals & Grievances Specialist
Medica
- Remote job
Medica, a nonprofit health plan serving communities across multiple states, seeks a remote Appeals & Grievances Specialist III to manage complex member complaints, grievances, and appeals with regulatory alignment. You will work with cross-functional teams to ensure timely, accurate resolutions and audit-ready documentation in support of compliant care. Ideal candidates have 3+ years in healthcare operations and at least 1 year on a dedicated appeals/grievances team, with strong regulatory #J-18808-Ljbffr Medica
- ...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 workWork from home
- ...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
- ...to work independently and manage multiple priorities in a remote setting.\n- Understands state and federal requirements\n-... ...Job Description An employer is looking for a remote Appeals & Grievances Specialist who will be responsible for managing and resolving appeals...Remote workWork at office
$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... ...experience, education and/or skill level. Seniority level Entry level Employment type Full-time...Remote workHourly payFull timeContract workWork experience placementWork at office$45.9k - $78.6k
...is the norm and every member feels valued. The Appeals & Grievances Specialist III role manages and resolves member complaints, grievances... ...time between 7 AM - 9 AM CT This position is a Remote role. To be eligible for consideration, candidates must have...Remote workWork experience placement$60.78k
...net required to achieve that purpose. Job Summary The Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider... ...work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical...Remote workLocal areaShift workWeekend 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...Remote work
- 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-Line Staffing Solutions in Georgia is seeking a Grievance & Appeals Coordinator I to manage the grievance and appeals workflow in a regulated... ..., accurate outcomes. This hybrid role offers office and remote work, standard business hours, and benefits after 90 days with...Remote jobWork at office
$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...Remote workHourly payPermanent employmentTemporary workWork experience placementShift work- ...Member Appeals Specialist Primary responsibilities would include triaging incoming appeals/grievances, categorizing them appropriately, assigning them to the team, making outbound calls when necessary. Also checking voicemails, responding to emails/voicemails. The...Remote workTraineeship
- ...for meetings and events, the full-time Senior Purchasing Specialist will manage creative program... ...procurement, and negotiation, while working remotely. Key responsibilities Coordinate large... ...team members and suppliers Develop appealing programs that maximize client budgets...Remote workSeniorFull timeWork at office
$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- ...required at an assigned work location. Any remote work is expected to be performed from an... ...findings and recommendations to senior management and stakeholders.Identifies opportunities... ...(i.e. rate case or other) filings and appeals.Works closely with senior management and...Remote workSeniorShift work
$66.3k - $79.8k
...Overview Resolves grievances, appeals and external reviews for VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Fully Integrated Dual Advantage (FIDA) and Select Health. Ensures regulatory compliance, timeliness requirements and...Work experience placementWork at officeFlexible hours$22 - $25 per hour
...communities." Western Health Advantage Western Health Advantage (WHA) is seeking a detail-oriented and customer-focused Appeals & Grievances Specialist to join our team. In this fast-paced role, you will support members by managing appeals and grievances while ensuring...Hourly payWork experience placement$105k
...negotiations, contract interpretation, grievance administration, performance... ...unions. Position Summary The Senior Labor Relations Specialist is responsible for providing strategic... ...position is hybrid working from your remote office and in-person based on business...Remote workSeniorContract workWork experience placementWork at officeLocal areaFlexible hours- ...Medical Branch (UTMB Health) is seeking a Sr. Patient Account Specialist in Galveston, TX. Hybrid remote work is available with a Monday-Friday schedule; the role focuses on billing third-party payers and appealing denied claims. The position requires experience in patient...Remote workSeniorMonday to Friday
- ...HCG, and CMS regulations. # Reviews all State Fair Hearing requests by members and providers, pulls case files, meets with Grievance & Appeals Manager for further review and action, which may include collaboration with others to avoid/reduce grievances, appeals, and/or...SeniorWork experience placement
- A healthcare service company is seeking a G&A Coordinator in Detroit, MI. This role involves processing appeals, grievances, and inquiries from members, requiring strong analytical and communication skills. The ideal candidate will have a bachelor's degree and experience...
- 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...Contract work
$29.32 - $36 per hour
Appeals And Grievances SpecialistLocation: Los Angeles, CAOnsite Flexibility: HybridPosition Type: ContractContract Duration: 3 months (extensions... ...at this time.Job SummaryThe Appeals and Grievances (A&G) Specialist will receive, investigate, and resolve member and provider...Local areaWork visaShift workDay shift- A national recruiting company is seeking a Business Grievance/Appeals Representative in Cerritos, California. The ideal candidate will review, analyze, and process claims, conduct investigations into customer grievances, and ensure proper communication with customers. Candidates...Contract work
- At Molina Healthcare, the Claims Appeals Specialist provides support for handling member and provider complaints, aligning with CMS standards... ...focuses on researching and resolving appeals, disputes, and grievances with timely communications to authorized representatives....
- ...The Senior Labor Relations Specialist serves as the principal labor relations subject matter expert supporting... ...interpretation, past practice, grievance handling, discipline, attendance,... ...Plant in Covert, Michigan. Regular remote work is not anticipated. Must be...Remote workSeniorContract workWork at officeLocal areaImmediate startFlexible hoursShift work
- Innova Solutions in Philadelphia, PA is seeking an Appeals & Grievances Specialist for a contract-to-hire role. The position focuses on managing appeals from receipt through resolution within regulatory timelines, analyzing benefits and evidence documents, and preparing...Contract work
- A national recruiting company is seeking a Grievance/Appeals Representative in Thousand Oaks, CA. The role involves reviewing claims, investigating customer grievances, and ensuring resolution of appeals. Candidates must possess a high school diploma and have 1 to 3 years...Contract 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...
$65k - $97.5k
...Parts Center - Troy Commerce Center Blvd Location Shift: 1st Workstyle: Remote Eligible up to 20% Career Level: 4 Job Grade: Exempt-2 Job Purpose The Purchasing Specialist (EX2) position within Recycling & Spec Control supports the overall mission and...Remote workSeniorFull timeTemporary workWork experience placementWork at officeRelocation packageShift work- ...Your Role The Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either... ...post-service or claim denial. The Appeals and Grievances RN Senior will report to the Manager of the Appeals and Grievances...SeniorFull timeWork at officeMonday to FridayShift work
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