- HCA Healthcare (Manchester, NH)
- …to join an organization that invests in you as a Medical Insurance Claims Appeals Representative ? At Parallon, you come first. HCA Healthcare has committed up ... to make a difference. We are looking for a dedicated Medical Insurance Claims Appeals Representative like you to be a part of our team. **Job Summary and… more
- Humana (Atlanta, GA)
- …of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... to achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Investigate and resolve medical necessity member appeals . Ensure compliance with state and federal ... Centers for Medicare and Medicaid Services requirements. Maintain all appeals documentation according to external agency requirements. **Supervision Exercised:** +… more
- Conduent (East Hartford, CT)
- …be part of a culture where individuality is noticed and valued every day. ** Appeals Coordinator - Customer Experience Associate IV** **Summary:** As an ** Appeals ... - Customer Experience** analyze and resolve verbal and written appeals from consumers. Respond to requests for information from...maintain good will and cooperation. + Act as a representative at Administrative Hearings conducted via phone or in… more
- St. Luke's University Health Network (Allentown, PA)
- …a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all ... determination made by the government or commercial payors, or their auditor representative . + Facilitate clinical chart reviews to assist with supporting assigned… more
- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The Coding Appeals Specialist retrospectively reviews patient medical records, claims data and coding of ... AMA CPT, are assigned to support the services/treatment rendered. The Coding Appeals Specialist also prepares appeal arguments and/or letters to support and defend… more
- Penske (Reading, PA)
- …audits, including negotiating with auditors and interfacing with taxing jurisdictions. -Perfect appeals and refund claims. -The position will require the ability to ... are required. **Physical Requirements:** -The physical and mental demands described here are representative of those that must be met by an associate to successfully… more
- Executive Office for US Attorneys and the Office of the US… (Richmond, VA)
- …an opportunity to work on their own caseload and handle their own trials and appeals as a representative of the United States. This office is hiring for ... two AUSAs in the Criminal Division of the Richmond Office. Guns, Violent Crimes, and Narcotics Unit: This Unit investigates and prosecutes a wide variety of violent and gang-related crimes, including murders, kidnappings, racketeering, firearms trafficking… more
- HANAC, Inc. (Astoria, NY)
- …integral part of a team with the immigration attorney, Board of Immigration Appeals (BIA) accredited representative , and support staff. The Immigration Paralegal ... will assist the staff attorney and the Program Director in providing legal services, education, and outreach, including coordination of community events, and working under attorney supervision to assist clients on Immigration law matters. The Paralegal will… more
- MyFlorida (Orlando, FL)
- 855772 - EMPLOYMENT SECURITY REPRESENTATIVE II - 40034030 Date: Jul 2, 2025 The State Personnel System is an E-Verify employer. For more information click on our ... 855772 Agency: Commerce Working Title: 855772 - EMPLOYMENT SECURITY REPRESENTATIVE II - 40034030 Pay Plan: Career Service Position...from claimants and employers or the Office of RA Appeals and the Reemployment Assistance Appeals Commission.… more
- US Tech Solutions (Myrtle Beach, SC)
- …Work Experience: 2 years of customer service experience including 1-year claims or appeals processing OR Bachelor's Degree in lieu of work experience. C2 clearance ... as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals . Determines whether to return, deny or pay claims following organizational… more
- Whidbey General Hospital (Coupeville, WA)
- JOB SUMMARY The Patient Financial Services Representative supports the mission of providing quality healthcare to the patients of WhidbeyHealth by performing a ... support the financial health and well-being of the organization. The PFS Representative may be responsible for coordinating patient referrals and subsequent follow… more
- Insight Global (Houston, TX)
- …A healthcare employer in Houston, TX is seeking an Insurance Follow Up and Denials Representative to join their team. This position is hybrid and will be onsite 1 ... the initial training period has been completed. In this position the representative will be responsible for reviewing denied or rejected insurance claims,… more
- CVS Health (Harrisburg, PA)
- …do it all with heart, each and every day. **Position Summary** Customer Service Representative is the face of Aetna and impacts members' service experience by manner ... new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. Educates providers on our self-service… more
- Robert Half Accountemps (Olathe, KS)
- …are offering a contract to hire employment opportunity for a Medical Claims Representative in Olathe, Kansas. This role is within the industry of healthcare, ... activities. The workplace is dynamic and fast-paced, expecting the Representative to handle various responsibilities related to medical claims, insurance,… more
- Guidehouse (Lewisville, TX)
- **Job Family** **:** Patient Account Representative **Travel Required** **:** None **Clearance Required** **:** None **What You Will Do** **:** The **Insurance ... Patient Account Representative - Hospital A/R Emphasis** is an extension of...Job Functions** + Hospital Claims + Account Review + Appeals & Denials + Medicare/Medicaid + Insurance Follow-up +… more
- Independent Health (Buffalo, NY)
- …culture that fosters growth, innovation and collaboration. **Overview** The Servicing Representative is a customer service professional who displays confidence, a ... listening towards all Pharmacy Benefit Dimensions (PBD) customers. The Servicing Representative functions as an advocate for all customers and resolves all… more
- Veterans Affairs, Veterans Health Administration (Charleston, SC)
- Summary The Prosthetic Representative must administer, supervise, and perform work dedicated to rendering prosthetic and sensory aid services to disabled patients. ... of Work for Service Contracts. Possesses and maintains Contracting Officer Representative (COR F AC) II certification. Establishes long and short-term program… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- About The Role The Customer Service Representative , Bilingual, assists members, physicians, hospitals, revenue agencies and other healthcare providers with member ... benefits, eligibility, claims inquiry, claim reconsiderations and appeals . The Customer Service Representatives must be able to work in various shifts Monday to… more
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