- CenterWell (Providence, RI)
- **Become a part of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by ... trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced… more
- Cognizant (Providence, RI)
- …or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances , precertification, initial and concurrent reviews . ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Beth Israel Lahey Health (Westwood, MA)
- …manner. 2. Resolves all PBM related billing problems and issues. 3 . Handle phone inquiries and initial prescription intake. 4. Multidisciplinary responsibilities ... address information. Escalates calls to pharmacists for clinical inquiries and escalates grievances to supervisor. 7. Maintains new and existing patient profiles and… more