- UpvoteDownvoteShare Job
- Suggest Revision
Assist the Appeals & Grievance Coordinators, Pharmacists, Medical Directors and Quality Improvement Coordinators with processing pharmacy benefit appeals and grievances. Core responsibilities include customer service, claims processing, prior authorizations, formulary exceptions, appeals, grievances, and project participation.
$45,850 - $55,500 a yearFull-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Liaison to Services team coordinating efficient and accurate member ad provider servicing as well as Grievance and Appeals processing according to CMS requirements and regulations.
ExpandUpdated 2 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Schedule: Monday - Friday 8:00 am to 4:30 pm PST Saturdays and Holidays requiredHow you will make an impact: Responsible for serving as a team lead and for investigating and processing the most complex grievances and appeals requests from members and providers and provide leadership and work direction to other appeals staff.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Manages the relationship with both new and established vendors, including but not limited to customer service, claims processing, enrollment, medical management, credentialing and grievance and appeals.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
- Suggest Revision
The Manager I - Grievance & Appeals is responsible for the management oversight of receipt, investigation and processing associated with member/provider grievance and appeals.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
The Grievance Resolution Specialist coordinates the Grievance and Appeal resolution process, responds to verbal and written Grievances and Appeals from members and/or providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions, and pharmacy and vision decisions.
$25 - $31 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Provides guidance on risks that may impact the appeals and grievance operations. Manages appeals and grievance process in accordance with the organization's policies and procedures.
ExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Direct and manage appeals and grievance staff in order to adhere to accurate processing and resolution of appeals and grievances. Demonstrate a solid understanding of the appeals and grievance processes, including all regulatory and reporting requirements.
ExpandUpdated 5 days ago - UpvoteDownvoteShare Job
- Suggest Revision
The Business Process Services (BPS) Manager is focused on the Enrollment, Membership, and Billing (EM&B) domain and responsible for overseeing department activities ensuring efficient, accurate, and compliant operational processing.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Knowledge of health care evaluation methodology, medical terminology, and regulations Strong organization and data management skills, including word processing, spreadsheets, monitoring and evaluation tools.
ExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Provide administrative Medicare Enrollment eligibility information support to Appeals & Grievance department. This will include developing and managing a quality assurance program for, but not limited to: application and eligibility verification, extracting OEC applications, processing enrollments, PBP changes, cancellations and disenrollments.
ExpandUpdated 2 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Performs oversight of the enrollment, billing, and membership operations ensuring efficient and accurate processing enrollment, maintenance and billing according to CMS requirements and regulations.
ExpandUpdated 5 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Serves as the internal expert on CMS EM&B processing guidelines and regulations. Serves as the internal expert on CMS and BlueCross BlueShield Service processing guidelines and regulations.
ExpandUpdated 5 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards. Assists in creation of reports, attends, and presents at Plan committee meetings (Grievance, SIC, etc.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Provides assistance and support to other departments, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc. Provides assistance and support to other departments, as needed, to obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals, SIU, etc.
Full-timeExpandApply NowActive JobUpdated Today
grievance appeals processing jobs
FEATURED BLOG POSTS
How to Make a Job Offer More Competitive
Money alone makes it hard to attract and retain top-notch candidates, especially when you are competing with larger businesses and corporations in your industry. So, instead of focusing on money, figure out how to make a job offer more competitive when you can't offer more money.
5 Ways to Stretch Your Hiring Budget
Many businesses across the country have adjusted business operations to make it through the pandemic. After a period of hardship, many business owners, like yourself, are ready to start recruiting and rebuilding a bigger, more skilled workforce - only now you have to do it with a smaller hiring budget.
How to Ask for a Raise at Work
Here we go again; it’s time to talk money. Whether you’re one year in at a new company or approaching year five on the same team, learning how to ask for a raise should be part of your long-term career plan. These conversations are rarely fun (thanks to society, which has conditioned us to believe that money is taboo), but they are necessary if you want to, well, get paid what you’re worth. Trust us, there’s a lot of money on the table for taking. Below, we’ll discuss tips on timing, approach, and follow-up.
Technology in the Workplace: How to Improve your HR Function with AI
It’s safe to say that the last two years have brought fundamental changes to the way we work and do business. Companies have relied on technology in the workplace to digitize their services and build a remote-friendly infrastructure that could prepare them for the future.
How to Maximize Action Verbs in Your Resume
Writing a resume that stands out takes more than using keywords and savvy formatting. It’s not just about having an impressive list of accomplishments. It’s also about how you position them using action verbs and deliberate word choice. So if you are looking for a way to craft a resume that stands out and gets calls back? Start by sprucing up your resume with captivating action verbs.
What is Your Desired Job Title?
You’ve decided to look for a new job. So now comes the question — what is your desired job title? There are lots of considerations to think through when deciding on the right title for your next role.
4 Things to Consider When Building a Global Workforce
The rise of remote work has given employers a unique chance to rethink how they approach workforce management. This ranges from rethinking the size and design of their office space to updating their tech stack to accommodate different working styles. It has created new opportunities for companies of all sizes to expand their hiring pool and look for top talent on a global scale.