Provider Appeals
4 weeks ago
Provider Appeals & Grievances SpecialistThis is a remote position open to any qualified applicant that lives in the United States. We are seeking a dedicated Provider Appeals & Grievance Specialist with 1 to 2 years of experience to join our team. The ideal candidate will have strong technical skills in MS Excel, knowledge/navigation skills for Microsoft programs in a fast paced, production driven environment and dedication to attendance adherence. Absences will not be permitted during training-approximately 6 weeks. This is a work-from-home position with day hours, and no travel is required. Candidate will also have the desire to further their abilities and knowledge of Medicaid medical insurance processes as they will be responsible for the research and resolution of Medicaid provider appeals that will involve research of member benefits, eligibility, provider contracts, billing and coding, Utilization Management and state Medicaid policies.Basic qualifications:2 years of Appeals and Grievance1 Year of medical claims processing experience (Must be with a healthcare plan, not on behalf of provider or provider's office)Medicaid & Medicare insurance customer service or claims processing2 Years of medical health insurance (Must be with a managed healthcare plan, not on behalf of provider or provider's office), Medicaid/Medicare Insurance Customer Service with managed care plans or directly with CMSBilling and Coding-Medical InsuranceKnowledge of Member/Provider Appeals and Grievances, processes, resolutions, complianceTAT Self-resolved troubleshooting ability for various IT issuesKnowledge of QNXTKnowledge of PEGAKnowledge of SharePointSense of urgency with production and responsiveness to email and MS TeamsAbility to create and fax written communication in a professional manner including spelling and grammarSalary and Other Compensation:Applications will be accepted until December 11, 2025. The hourly rate for this position is between $17.00 18.00 per hour, depending on experience and other qualifications of the successful candidate. This position is also eligible for Cognizant's discretionary annual incentive program, based on performance and subject to the terms of Cognizant's applicable plans.Benefits:Medical/Dental/Vision/Life InsurancePaid holidays plus Paid Time Off401(k) plan and contributionsLong-term/Short-term DisabilityPaid Parental LeaveEmployee Stock Purchase PlanDisclaimer: The hourly rate, other compensation, and benefits information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law. Cognizant is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.
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Appeal and Grievance Coordinator
2 days ago
Oklahoma City, OK, United States CVS Health Full timeAt CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for...
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Appeal and Grievance Coordinator
2 weeks ago
Oklahoma City, OK, United States CVS Health Full timeAt CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for...
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Appeal and Grievance Coordinator
2 weeks ago
Oklahoma City, OK, United States CVS Health Full timeAt CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for...
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Director, Home Health Grievances
4 days ago
Oklahoma City, United States Oklahoma Staffing Full timeDirector Denials ManagementBecome a part of our caring community and help us put health first. The Director Denials Management provides leadership for the audit, appeal, and review process to preserve and recover revenue while maintaining the highest level of clinical and regulatory integrity and compliance. Manages the Denials Management data analytics,...
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Director, Home Health Denials
3 days ago
Oklahoma City, United States Humana Inc Full timeA healthcare services provider in Oklahoma City seeks a Director of Denials Management to lead audit and appeal processes. The role requires strong leadership, analytical skills, and expertise in healthcare policy. Responsibilities include supporting clinical leadership with audit trends, developing education plans, and maintaining performance improvement...
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Director, Home Health Denials
4 days ago
Oklahoma City, United States Humana Inc Full timeA healthcare services provider in Oklahoma City seeks a Director of Denials Management to lead audit and appeal processes. The role requires strong leadership, analytical skills, and expertise in healthcare policy. Responsibilities include supporting clinical leadership with audit trends, developing education plans, and maintaining performance improvement...
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RN Appeals and Grievances
2 weeks ago
Jersey City, United States TalentHub Workforce, Inc Full timeJob description: Our client, a large nonprofit hospice and palliative care company is seeking a qualified candidate to join their team. In this role, we are looking for someone who is a Registered Nurse in the state of New York to work in the appeals and grievances department. This is a fantastic opportunity for a registered nurse to work for a nonprofit...
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RN Appeals and Grievances
2 days ago
Union City, NJ, United States TalentHub Workforce, Inc Full timeJob description: Our client, a large nonprofit hospice and palliative care company is seeking a qualified candidate to join their team. In this role, we are looking for someone who is a Registered Nurse in the state of New York to work in the appeals and grievances department. This is a fantastic opportunity for a registered nurse to work for a nonprofit...
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RN Appeals and Grievances
2 days ago
Union City, NJ, United States TalentHub Workforce, Inc Full timeJob description: Our client, a large nonprofit hospice and palliative care company is seeking a qualified candidate to join their team. In this role, we are looking for someone who is a Registered Nurse in the state of New York to work in the appeals and grievances department. This is a fantastic opportunity for a registered nurse to work for a nonprofit...
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RN Appeals and Grievances
2 days ago
Union City, NJ, United States TalentHub Workforce, Inc Full timeJob description: Our client, a large nonprofit hospice and palliative care company is seeking a qualified candidate to join their team. In this role, we are looking for someone who is a Registered Nurse in the state of New York to work in the appeals and grievances department. This is a fantastic opportunity for a registered nurse to work for a nonprofit...
