appeals

The Appeals Specialist is responsible for the timely, accurate, and compliant investigation and resolution of member and provider appeals and grievances. This role conducts comprehensive case research, evaluates applicable benefit plans, claims history, eligibility information, provider records, clinical or administrative documentation, and the...

Summary We are currently hiring a Part A/HHH Appeals Specialist at one of our subsidiary companies called CGS Administrators. CGS has been a proven provider of administrative and business services for state Medicaid agencies, managed care organizations, commercial health plans, Medicaid members, Medicare beneficiaries, healthcare providers, and medical...

Summary We are currently hiring a Part A/HHH Appeals Specialist at one of our subsidiary companies called CGS Administrators. CGS has been a proven provider of administrative and business services for state Medicaid agencies, managed care organizations, commercial health plans, Medicaid members, Medicare beneficiaries, healthcare providers, and medical...

Summary Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the...

Summary Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the...

Who We Are At Lucet, we’re transforming whole-person care. We deliver integrated behavioral and physical health solutions that connect individuals to the right care at the right time—improving outcomes and overall well-being. Serving over 15 million lives across the U.S. and Puerto Rico, our model combines clinical expertise, compassionate care, and...

Summary Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the...

Summary Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's...

Summary Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's...

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Appeals Coordinator based in United States. This role is responsible for coordinating and managing appeal cases while ensuring decisions are handled accurately and within required timeframes. You will maintain a caseload, review...

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Appeals Coordinator based in United States. This role is responsible for coordinating and managing appeal cases while ensuring decisions are handled accurately and within required timeframes. You will maintain a caseload, review...

POSITION SUMMARY: The Appeals Assistant: Responsible for ensuring professional handling of all provider appeals in a timely, compliant, and efficient way as well as be responsible for the daily office operations, procedures, and resources to facilitate organizational effectiveness and efficiency.REPORTS TO: Compliance Appeals ManagerSUPERVISES:...

Meet True VetAt True Vet Solutions, we believe no veteran should have to fight alone for what they already earned.Every day in America, veterans walk away from disability benefits they qualify for, not because they don't deserve them, but because the system meant to serve them is slow, confusing, and built to wear people down. We exist to change that. We...

To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here.Job SummaryThe Appeals Analyst reviews and responds to appeals and inquiries from members, providers, authorized representatives, insurance departments, and/or other regulatory bodies regarding adverse benefit determinations within the timeframes set forth in both...

Job Description. Process appeals and grievances, analyze, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines. Contact customers to gather information and communicate disposition of case. Conduct pertinent research in order to evaluate, respond to, and finalize case. Familiar with standard...

Overview Assists in the analysis and preparation of responses to payor denials and develop strong appeals for the purpose of securing reimbursement for acute care services provided to patients. Assist in development of strategies for denial prevention based on identification of patterns and trends identified during the course of appeals...

Wellfleet, a Berkshire Hathaway company, delivers customer-centric accident and health insurance, with quality service and uncompromising ethics. Wellfleet works to protect people against risk throughout every stage of life – from grade school to college to the workplace. Founded in 1993 as Consolidated Health Plans (CHP), Wellfleet, headquartered in...

Your Tomorrow is Here!Temple University Hospital is a nationally respected teaching hospital on Temple University's bustling Health Sciences Center campus. The hospital provides a comprehensive array of healthcare services both basic and complex to patients from around the corner, across the country and around the world.  As the chief clinical training...

Summary Responsible for maintaining the proper flow of the request for appeals.Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance...

The Appeals & Grievances (A&G) unit processes member and non-contracted provider appeals for all of HF’s line of businesses which include commercial, Medicaid, dual enrollments, Medicare and complete care. Appeals Specialist is the subject matter expert responsible for non-clinical case development and case resolution while ensuring compliance with...