Position Summary: The Appeals & Grievances Clinical Specialist is responsible for receiving, investigating and responding verbally and in writing to member and provider clinical appeals and grievances. Duties and Responsibilities: Ensures that appeals and grievances are properly classified (e.g.
Become a part of our caring community The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if a grievance, appeal or further request is warranted
Become a part of our caring community The Grievances & Appeals Representative 3 manages members and provider denials and concerns through conducting a comprehensive analytic review of clinical documentation to determine if a grievance, appeal or further request
JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers
Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the
Claims Support Specialist Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for
Appeals And Grievances Medical Director At UnitedHealthcare, were simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better.
Appeals And Grievances Medical Director At UnitedHealthcare, were simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better.
Appeal & Grievance Coordinator Reviewer I We are seeking an Appeal & Grievance Coordinator Reviewer I to review and research medical appeals and grievances, analyze claims and medical records, and ensure timely resolution in compliance with HIPAA, CMS, and
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the
SUMMARY: Contribute to the professional standing and profitability of the company by supplying customers with outstanding service and results, as well as meeting the performance standards of this role. These are achieved by consistently recruiting, pro-actively
The Regional Clinical Director (RCD) will work with providers in their assigned territory to educate and offer support to all providers: core providers, and traditional fellows. The Regional Clinical Director will work to support and implement
Who is Disability Rights Wisconsin? Disability Rights Wisconsin is Wisconsin’s Protection and Advocacy system. The agency is charged with protecting the rights of individuals with disabilities and keeping them free from abuse and neglect. Employing a
Celonis is the global leader in Process Intelligence and the pioneer of Process Mining technology. As one of the world’s fastest-growing enterprise SaaS companies, we are changemakers pushing the boundaries of what’s possible. We invest heavily
Company Description About us Hello, we’re Reach. Every day, our trusted news, stories and content connect with millions of people where they live - whether that’s on their social feed or at their neighbourhood newsstand; through
SUMMARY: Contribute to the professional standing and profitability of the company by supplying customers with outstanding service and results, as well as meeting the performance standards of this role. These are achieved by consistently recruiting, pro-actively
Join Martins Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of people caring for people, Martins Point employees are
Company Description This is a Citywide Exam posting. Your application to this posting is an application to take a citywide exam. If you pass the exam, you will be emailed your score and ranking on the
People Experience Leader – Manufacturing Operations Who We Are Essity is a global leader in health and hygiene headquartered in Stockholm, Sweden, with a North American headquarters located in Philadelphia, PA. We are a multi-billion-dollar company
Employee Relations Specialist The Role: The Employee Relations (ER) Specialist supports INIZIOs processes, policies, and strategy across ER. You will act as a liaison between legal and business matters. In this role, you will act as