- CenterWell (Boston, MA)
- **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 (Boston, MA)
- …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
- Transdev (Readville, MA)
- …of internal policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances . + Understand legal requirements and ... (2) weeks + Sick days: 5 days + Holidays: 12 days; 9 standard and 3 floating + Other standard benefits: 401(k) retirement plan, medical, dental and vision, life… more
- Commonwealth Care Alliance (Boston, MA)
- …and supports, and community supports as approved + Supports escalation of member grievances and appeals + Supports the procurement of network providers and ... medical, behavioral health, and social needs **Desired Experience (nice to have):** + 3 + years of minimum experience working in outreach or in the community caring… more
- Commonwealth Care Alliance (Boston, MA)
- …schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and ... AHIMA or Medicaid billing-related certifications **Required Experience (must have):** + 3 + years in healthcare claims processing, provider reimbursement, or payment… more