Medicare Claims Appeals Specialist

Job SummaryThe Appeals and Grievances Specialist I will support the Appeals and Grievances team in receiving, investigating, and resolving member and provider complaints and appeals. This role will escalate complex issues or questions to leadership as appropriate.Key ResponsibilitiesLearn the specialty level appeals and grievances work by resolving less...

Job SummaryWe are seeking a highly organized and detail-oriented Appeals and Grievances Specialist II to join our team at Insight Global. As a key member of our Appeals and Grievances team, you will be responsible for receiving, investigating, and resolving member and provider complaints and appeals in a timely and efficient manner.Key...

Job Summary: We are seeking a highly skilled Appeals and Grievances Specialist II to join our team at Insight Global. As a key member of our Appeals and Grievances team, you will play a critical role in receiving, investigating, and resolving member and provider complaints and appeals.Key Responsibilities:Support the Appeals and Grievances team in receiving,...

Job SummaryWe are seeking a highly motivated and detail-oriented Appeals and Grievances Specialist I to join our team at Insight Global. As a key member of our Appeals and Grievances team, you will play a critical role in supporting the investigation and resolution of member and provider complaints and appeals.Key ResponsibilitiesInvestigate and resolve less...

Job SummaryThe Claims Examiner position is a critical role within our organization, responsible for ensuring the accurate and timely adjudication of paper and/or electronically formatted claims received in the CMS 1500 and/or UB-04 format. This position requires a strong understanding of Medicare and Medi-Cal regulatory guidelines, contract provisions, and...

Job SummaryThe Claims Examiner position is a critical role within our organization, responsible for ensuring the accurate and timely adjudication of paper and/or electronically formatted claims received in the CMS 1500 and/or UB-04 format.Key Responsibilities:Process all claims and applicable claims correspondence in accordance with Medicare and Medi-Cal...

Medicare Advantage EDI AnalystTake your career to the next level at UCLA Health, a world-renowned health system with a strong commitment to excellence.As a key member of our Medicare Advantage Operations team, you will play a critical role in maintaining and running processes for electronic claims and other EDI transactions.Responsibilities include working...

Job DescriptionThe Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II is responsible for providing ongoing training on the core processing system, A&G processing procedures, training regulatory changes which will affect established procedures, working with the quality team on quality and performance guidelines, creating and...

Job Summary:Manager II Grievance/Appeals is responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to client/provider grievances/appeals and ensure compliance with regulatory requirements.Key Responsibilities:Maintains and coordinates staff activities to achieve departmental and corporate goals...

Appeals & Grievances Supervisor OpportunityInsight Global is seeking a skilled Appeals & Grievances Supervisor to join our team in a mostly remote role with occasional on-site work in Downtown Los Angeles.Key Responsibilities:Lead and direct a team of professionals handling appeals and grievances, ensuring thorough investigations and timely...

Job DescriptionJob Title: Customer Solutions Center Appeals and Grievances Training Specialist IIJob Type: Hybrid | PermanentLocation: Los Angeles, CA (Position will be Hybrid - will be conducting combination WebEx and in near future Onsite Trainings)Required Skills:3 years experience in Healthcare Industry3 years experience designing and conducting...

Job SummaryMedPOINT Management is seeking a highly skilled Medical Claims Recovery Specialist to join our team. As a key member of our team, you will be responsible for preparing, submitting, and auditing payments for high-cost members who meet our clients' Stop Loss deductible thresholds.Key ResponsibilitiesRun monthly Stop Loss reports for each client to...

Job SummaryWe are seeking a skilled Claims Examiner to join our team at Preferred IPA of California. As a Claims Examiner, you will be responsible for accurately and efficiently processing medical claims in accordance with Medicare and Medi-Cal regulatory guidelines.Key Responsibilities:Process and adjudicate paper and electronically formatted claims in a...

Job OverviewThrifty Management Services, the dedicated MSO for Preferred IPA of California, seeks a skilled Claims Examiner to join their team. As a Claims Examiner, you will play a critical role in ensuring the accurate and timely adjudication of paper and/or electronically formatted claims received in the CMS 1500 and/or UB-04 format.Key...

Job SummaryThe Appeals and Grievances Supervisor is responsible for leading a team that handles appeals and grievances in the healthcare industry. This role involves supervising and supporting team members, monitoring research and resolution of appeals and grievances, and ensuring thorough investigations are completed according to company policies and...

Job Title: Customer Solutions Center Appeals and Grievances Training Specialist IIThe Customer Solutions Center Appeals and Grievances Training Specialist II is a key member of our team, responsible for providing ongoing training on the core processing system, A&G processing procedures, and regulatory changes that impact established procedures. This role...

Job SummaryUCLA Health is seeking a highly skilled EDI Analyst to join our Medicare Advantage Operations team. As a key member of our team, you will be responsible for maintaining and running processes for electronic claims and other EDI transactions.Key ResponsibilitiesWork with external trading partners to transfer and load data through secure channelsTest...

Job SummaryUCLA Health is seeking a highly skilled EDI Analyst to join our Medicare Advantage Operations team. As an EDI Analyst, you will play a critical role in maintaining and running processes for electronic claims and other EDI transactions.Key ResponsibilitiesWork with external trading partners to transfer and load data through secure channelsTest...

Job Title: Appeals and Grievances SupervisorThe Appeals and Grievances Supervisor plays a critical role in ensuring the efficient resolution of appeals and grievances within the Customer Solution Center. This position involves leading a team of professionals who handle the intake, research, resolution, tracking, and reporting of appeals and grievances.Key...

Job DescriptionKey ResponsibilitiesWe are seeking an experienced Workers Compensation Specialist to assist with claims investigations and settlement negotiations for our main claims management client.Key ResponsibilitiesAnalyze and process complex workers' compensation claims by investigating and gathering information to determine exposure.Negotiate...