- Humana (Boston, MA)
- …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 (Canton, MA)
- …responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for ... (https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance… more
- Transdev (Readville, MA)
- …of internal policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances . + Understand legal requirements and ... + Manage the grievance process and provide comprehensive responses to complaints, grievances , and arbitrations that support the Company's decision and comply with… 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 ... Standard office equipment Physical Requirements: + The physical demands described here are representative of those that must be met by an employee to successfully… more
- Highmark Health (Boston, MA)
- …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