- Adecco US, Inc. (Ontario, CA)
- Adecco is assisting a local client recruiting for Clinical Appeals Representative opportunities in Ontario, CA (90% remote). This is an excellent opportunity to ... culture and make an impact in the healthcare industry. If a Clinical Appeals Representative role sounds like something you would be interested in, and you meet… more
- Humana (Helena, MT)
- …a part of our caring community and help us put health first** The Appeals Representative 4 Investigates and resolves member and practitioner issues. manages ... determine if an a grievance, appeal or further request is warranted. The Appeals Representative 4 + Review documents + Building cases + Inventory Management +… more
- Humana (Baton Rouge, LA)
- …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
- State of Colorado (Denver, CO)
- …review must be submitted on the official appeal form, signed by you or your representative . Appeals to the State Personnel Board or the State Personnel Director ... must be received or postmarked within the filing period: Appeals shall be filed with the Board no later...### Email filings: dpa_###@state.co.us For more information about the appeals process, the official appeal form, and how to… more
- Commonwealth of Pennsylvania (PA)
- Appeals Referee Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5055524) Apply Appeals Referee Salary $77,379.00 - $117,497.00 Annually ... of Labor & Industry is excited to welcome an Appeals Referee to our dedicated team in the Hermitage...B. I have experience as a legal or non-legal representative of parties to quasi-judicial administrative hearings conducting direct… more
- Point32Health (MA)
- …(https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
- AmeriHealth Caritas (Newark, DE)
- …about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances, this position is responsible for the ... administrative tasks for coordination of member and/or provider appeals , the analysis of claims and appeals ,... system and documents, all correspondence with a member/participant, representative and/or a provider, related to an appeal or… 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
- Executive Office for US Attorneys and the Office of the US… (Newport News, 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 ... part of a dedicated team helping to prosecute federal criminal cases and prepare appeals in the Major Crimes Unit. This Unit investigates and prosecutes a wide… more
- Northwell Health (Melville, NY)
- …and medical necessity for assigned case. Collaborates with physician advisor, payor representative and site case managers to facilitate appropriate level of care ... current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and accurately reflect patient's severity of illness… 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
- Iowa Department of Administrative Services (Bettendorf, IA)
- Gaming Representative Print (https://www.governmentjobs.com/careers/iowa/jobs/newprint/5073573) Apply Gaming Representative Salary $26.54 - $40.23 Hourly ... IA Job Type Full-time Job Number 26-00629 Agency 429 Department of Inspections, Appeals & Licensing - Racing & Gaming Commission Opening Date 09/09/2025 Closing Date… more
- State of Minnesota (St. Paul, MN)
- **Working Title** **: Veterans Claims Representative ** **Job Class: Veterans Claims Representative ** **Agency: Minnesota Department of Veterans Affairs** + **Job ... and their dependents by preparing and monitoring claims and appeals before the US Department of Veterans Affairs, Decision...Officers (DROs) and the United States Board of Veterans Appeals (BVA). A successful incumbent in this role will… more
- Independent Health (Buffalo, NY)
- …and 5pm** **Monday through Friday** . **Overview** The Provider Relations Representative will be responsible for assisting our provider constituents and providing ... exceptional customer service. The Provider Relations Representative will answer incoming calls from health care providers including physician offices, ancillary… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Account Representative position is responsible for resolving all outstanding third party primary and secondary insurance claims for ... billing functions, including claims resubmission to payors. + Creates and submits appeals when necessary. Engages the coding follow-up team for any medical necessity… 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
- 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
- New York State Civil Service (Menands, NY)
- NY HELP Yes Agency Labor, Department of Title Labor Services Representative /Trainee 1/2 - Menands (NY HELPS) Occupational Category Other Professional Careers Salary ... Zip Code 12204 Duties Description Standard Duties:As a Labor Services Representative /Trainee 1/2 with the Unemployment Insurance Appeal Board (UIAB), the incumbent… more
- CVS Health (Hartford, CT)
- …do it all with heart, each and every day. **Position Summary** Customer Service Representative is the face of Aetna and impacts members' service experi‐ ence by ... new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. Educates providers on our self-service… 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
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