- Robert Half Accountemps (Eden Prairie, MN)
- Description Clinical Appeals Representative (Contract - Fully Remote) We're seeking a detail-oriented Clinical Appeals Representative to join our ... health insurance operations by managing documentation, coordinating with providers, and ensuring appeals and grievances are processed accurately and on time. This is… more
- Humana (St. Paul, MN)
- …Become a valued member of Humana's Internal Review Team as a Grievances & Appeals Representative , where you will play a critical role in addressing client ... In this position, you will perform thorough reviews of clinical documentation to assess whether grievances, appeals ,...of clinical documentation to assess whether grievances, appeals , or additional requests are justified, and provide final… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …needs across the continuum of care by leveraging member partnership, pre-service clinical utilization review, case and disease management processes, skill sets and ... and eligibility in a call center environment. * Conducts comprehensive clinical assessments; gathers, analyzes, synthesizes and prioritizes member needs and… more
- Highmark Health (St. Paul, MN)
- …of benefit billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as ... obtain necessary and/or additional information when necessary. + Consult with staff clinical pharmacist for guidance and assistance as necessary. + Document all… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …domains, including utilization management, prior authorization, claims, denials, and appeals . Their work goes beyond extraction; it involves interpreting nuanced ... as Network and Pharmacy, ensuring data is pulled using the most representative methods. They also support high-risk regulatory reporting, where precision and speed… more