- Evolent (Honolulu, HI)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The ** Coordinator , Appeals and Grievances ** at Evolent is responsible for reviewing ... prior authorization experience. This role is distinct from other coordinator positions in that it is dedicated to case...required. + Minimum of 3 years' experience in an Appeals and Grievances role or comparable administrative… more
- Highmark Health (Honolulu, HI)
- …through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as a resource for technical ... staff. + Other duties as assigned or requested. **QUALIFICATIONS:** **Minimum** + High school diploma or GED + Experience in pharmacy prescription claims processing/submission/payment. **Preferred** + Associate degree + Pharmacy technician certification… more
- TEKsystems (Honolulu, HI)
- …Conducts critical analysis of highly complex and sensitive member and provider appeals , inquiries and grievances and applies internal policies and procedures, ... position and concerns to management and decision makers. Assists Supervisor and Coordinator in working as a liaison with providers, members and internal decision… more