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The Claims Supervisor is responsible for the day-to-day management of the Senior Analyst claims team, who handle a variety of tasks including, but not limited to, Customer emails, Correspondences, Grievance and Appeals, HRA, Balance Bills and Transplants, enabling the team to deliver exceptional service to our customers.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Assist Members with but not limited to (benefits, PCP lookup, appointment setting, scheduling transportation, and documenting Grievance and/or appeals). The Member Care Professional may also facilitate the process for Health-Education related activities and other Health Plan functions and events.
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Minimum Requirements:Requires a BA/BS and minimum of 2 years related experience preferably in healthcare insurance departments such as Grievance and Appeals, Contracting or Claim Operations, law enforcement; or any combination of education and experience, which would provide an equivalent background.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Commercial Grievance and Appeals knowledge is highly preferred. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
ExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Be proactive in educating members, providers and others about CHRISTUS Health plans appeal/grievance process, plan terminations, contract terminations and benefit summary. Clinical Appeals Specialist - TLRA Revenue Cycle.
Full-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Requires a BA/BS and minimum of 2 years related experience preferably in healthcare insurance departments such as Grievance and Appeals, Contracting or Claim Operations, law enforcement; or any combination of education and experience, which would provide an equivalent background.
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Established in 1984, CDPHP is a physician-founded, member-focused, and community-based not-for-profit health plan that offers high-quality affordable health insurance to members throughout New York. The company values people, quality, innovation, and community, and its corporate culture supports those values wholeheartedly.
ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Job Description :Nurse Appeals- California candidates only Location: This is a virtual position and prefer candidates reside within 50 miles of an Elevance Health PulsePoint location. Documents and logs appeal/grievance information on relevant tracking systems and mainframe systems.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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TheCSR guides the member through their members plan of benefits, Aetna policy and procedures as well as having knowledge of resources tocomply with any regulatory guidelines. Handles incoming requests for appeals and preauthorization not handled by Clinical Claim Management.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Actively participates in the functioning of the plan grievance and appeals procedures. The incumbent will collaborate with the other Medical Directors and clinical, nursing and non-clinical leadership staff across the organization in areas including Quality Management, Utilization and Care Management, Health Education/Disease Management, Long Term Care, Pharmacy, Behavioral Health Integration, Program for All Inclusive Care for the Elderly (PACE) as well as support departments including Compliance, Information Technology Services, Claims, Contracting and Provider Relations.
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Report member complaints to Appeals and Grievance team for investigation and follow-up, per protocol. Maintain working knowledge of COA and OHP benefits including physical health and behavioral health (RNCC/AI AN will maintain working knowledge of Native American Oregon Health Plan Fee For Service program benefits.
$87,135 - $105,435 a yearFull-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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The Grievance and Appeals Coordinator will also present cases to the Appeals Committee. The Appeals and Grievance Coordinator will coordinate, process, and document all aspects of member appeals and grievances, as well as provider appeals across all our product offerings (Commercial, Medicaid and Medicare.
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This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits.
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Prefer experience in Health Plan Services, Provider Relations, Member Relations, Healthcare Marketing & Engagement, or Claims. (0%) Works with various team members to obtain necessary information to address contract, configuration, claims, Credentialing, Grievance & Appeals, and other provider related matters.
$60,314 - $87,695 a yearExpandApply NowActive JobUpdated 4 days ago
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