- Humana (Annapolis, MD)
- …us put health first** Become a valued member of Humana's Internal Review Team as a Grievances & Appeals Representative , where you will play a critical role ... you will perform thorough reviews of clinical documentation to assess whether grievances , appeals , or additional requests are justified, and provide final… more
- Point32Health (Washington, DC)
- …responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for ... + Must be able to organize, plan and implement the functions of Member Appeals and Grievances , maintain timelines and turnaround times to meet multiple… more
- Navy Exchange Services (NEX) (Bethesda, MD)
- …discipline. Provides guidance and assistance to management on disciplinary actions, grievances , and appeals . Ensures appropriateness of charges and penalties. ... across the entire workforce. Supervises subordinate exempt Human Resources Representative . Duties and Responsibilities: - As District Human Resources Managers,… more
- Highmark Health (Washington, DC)
- …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 certificate +… more