Appeals Grievances jobs

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Grievances and Appeals Medical Director, CA Commercial busin...
Anthem, Inc. - 2,472 reviews - Los Angeles, CA 90046
Grievances and Appeals Medical Director, CA Commercial business. Responsible for reviewing member and provider appeals, grievances and arbitration process...
Quality Reviewer
MetaStar, Inc. - Madison, WI 53713
$55,000 - $65,000 a year
Review and mediation activities associated with FC, FCP, PACE, IRIS waiver programs member appeals and grievances....
Easily apply
Regional Vice President I Sr. Clinical Officer- Wisconsin-13...
Anthem, Inc. - 2,472 reviews - Waukesha, WI
Chair the Anthem BCBS WI Grievance Committee weekly. Chair the committee on Wednesday morning and make decisions on grievances including listening to 1-2...

Member Services Representative (8:00am-5:00pm)

Peoples Health, Inc. - 50 reviews - Metairie, LA
The Member Services Representative handles inquiries, concerns, complaints, grievances and appeals in a professional manner by listening to the member and...

Clinical Appeals Reviewer

UnitedHealth Group - 9,637 reviews - San Francisco, CA   +4 locations
1+ years of Medical / Behavioral Health Appeal & Grievance experience. Handle high claims and appeal volume while using internal Claim, UM / UR Behavioral...

HR Site Generalist

Scentsy - 299 reviews - Lexington, KY 40509
Gather information for UI claims and work with the Legal department on response and appeal hearings, as necessary....

Clinical Appeals Analyst

Blue Cross Blue Shield of North Carolina - 4,852 reviews - Winston-Salem, NC
Identify and take corrective action on appeals that result from noncompliance of contract provisions, appeal guidelines and/or CMP....

Clinical Appeals Specialist

Health Partner Plans, Inc. - Philadelphia, PA 19107 (City Center East area)
Keeps current with all rules, regulations, policies and procedures relevant to the Complaints, Grievances and Appeals Unit....
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Appeals and Grievances Investigator

University of Maryland Medical System Health Plans - Hunt Valley, MD
Keeps current with all requirements of DHMH plan grievances and appeals. Conducts analysis, investigation and resolution of member appeals and grievances....
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Service Center Representative

Blue Cross Blue Shield of Arizona Advantage - 4,852 reviews - Phoenix, AZ 85029 (North Mountain area)   +1 location
Capture any complaint or dispute expressing dissatisfaction and process as a grievance or appeal on behalf of the member....

Clinical Appeals Reviewer

WellCare - 779 reviews - Tampa, FL 33634
3000 - HS - Appeals & Grievances. Communicates the outcome of the appeals process with members, internal and external partners....


Arizona Health Care Cost Containment System - 6 reviews - Phoenix, AZ
$40,000 - $46,624 a year
The Human Rights Advocate 1 is responsible for advocacy and grievance, administrative appeal and discharge planning processes ....

Customer Service Rep

Aetna - 2,654 reviews - New Albany, OH   +1 location
Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system....
Medical Director - Remote
Fidelis Care - 203 reviews - Rego Park, NY 11374
Conducts concurrent and retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. Medical Director - Remote....
Senior Appeals Representative
UnitedHealth Group - 9,637 reviews - Dallas, TX 75215
UHG, Appeals Representative, Grievances Rep., Customer Service Rep. Analyzes and identifies trends for all appeals and grievances....