Source Job

$43,000–$56,200/yr

  • Manages client denials and concerns through analytic review of clinical documentation.
  • Delivers final determination based on skillsets and partnerships with Humana parties.
  • Investigates and resolves member and practitioner issues via phone or face to face to support quality goals.

Customer Service Data Entry Microsoft Word Microsoft Excel

20 jobs similar to Grievances & Appeals Representative 3

Jobs ranked by similarity.

$30,534–$57,345/hr
US

  • Responsible for accurately and respectfully responding to inquiries from employees/members, providers and clients in a high volume call center.
  • Seamlessly navigate multiple system applications/screens and resources to accurately respond to inquiries.
  • Thoroughly and accurately document all inquiries and actions taken using applicable software applications.

Luminare Health helps clients and brokers design custom self-funded healthcare plans providing innovative solutions, flexibility, complete data transparency, and member-centered support. They rely on their decades of industry experience and proven, data-driven results to deliver optimal benefits solutions, customized to meet our clients’ needs.

$1,327–$1,327/yr
Mexico 2w PTO

  • Establishes a connection with customers to gather and capture information, to file a first notice of loss claim
  • Provides an overview of the basic claims process and information of a general nature to customers.
  • Receives, screens, and routes incoming telephone calls and other electronic correspondence.

Integon is a division in Mexico of one of the largest insurance companies in the United States of America. They provide support to its insurance company affiliates, offering property and casualty insurance products and have been certified as a Great Place To Work since 2019.

$40,000–$41,000/yr
US

  • Correspond with callers providing benefit information, claim status, or general health plan information.
  • Thoroughly and accurately answer questions about customers’ healthcare accounts.
  • Handle 35-50+ inbound and outbound phone calls per day.

Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs.

US

  • Assists with medical record documentation requests and leverages medical management system to initiate case and/or authorization to support clinical processes.
  • Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes.
  • Actively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership.

Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote it one of the “Best Places to Work in PA”.

  • Serving as the first point of contact for members and providers.
  • Navigating multiple systems and balancing several interactions at once.
  • Documenting thoroughly, taking ownership of issues, and following through until every customer feels heard and supported.

Guidehealth is a data-powered healthcare company dedicated to operational excellence. They aim to make healthcare affordable, improve patient health, and restore fulfillment for providers. Driven by empathy and powered by AI, Guidehealth leverages remotely-embedded Healthguides and a Managed Service Organization.

US

  • Administer FMLA, State, ADA, and company leaves, adhering to state and federal guidelines and customer policies.
  • Handle a high volume of Bilingual Spanish incoming calls promptly and professionally, providing efficient follow-up via phone and email.
  • Maintain complete and accurate leave documentation within our database, demonstrating respect and confidentiality for callers.

ComPsych is a global leader in organizational mental health, well-being, and absence management, dedicated to maximizing human potential in workplaces. They serve over 75,000 customers worldwide, impacting over 160 million lives across 200 countries, combining technology with human expertise.

$41,600–$49,920/hr
US

  • Provide high-level customer service to patients and fellow employees.
  • Review and update billing, codes, and account information.
  • Ensure accurate billing for all services provided, adhering to compliance.

Hanger, Inc. is the world's premier provider of orthotic and prosthetic (O&P) services and products. With 160 years of clinical excellence, Hanger's vision is to lead the orthotic and prosthetic markets by providing superior patient care, outcomes, services and value.

US

  • Connect with customers via phone/email/chat/and or social media to resolve their questions or concerns
  • Calmly attempt to resolve and de-escalate any issues
  • Escalate interactions when necessary and appropriate

TP is a global, digital business services company. They deliver the most advanced, digitally powered business services to help the world’s best brands streamline their business in meaningful and sustainable ways. TP has more than 500,000 inspired and passionate people speaking more than 300 languages and a global scale and local presence.

US 5w PTO

  • Process transactions on insurance accounts and interact with insurance companies.
  • Communicate with staff and third-party customers to ensure accurate processing.
  • Prioritize accounts to maximize aged AR resolution, and research documentation.

Oregon Health & Science University values a diverse and culturally competent workforce. They are proud of their commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status.

US

  • Coordinate the delivery of medical equipment and verify order details.
  • Troubleshoot patient issues regarding equipment delivery or usage.
  • Collaborate with internal teams to ensure timely resolution of patient concerns.

This position is posted by Jobgether on behalf of a partner company.

US

  • Handle inbound participant and TPA calls, emails, and voicemails.
  • Resolve client issues, concerns, and inquiries regarding benefit programs.
  • Support the outside sales team by researching and assisting with operational questions.

Five Star Call Centers provides customer service solutions. They focus on delivering exceptional customer experiences in a fast-paced environment.

$45,760–$58,240/hr
US

  • Ensure timely and accurate payment of medical claims, following health plan policies and procedures.
  • Maintain accurate and up-to-date notes of all claims processed.
  • Process appeals and disputes by gathering and verifying claim information and communicating outcomes.

Sana Benefits aims to create an easy healthcare experience. They focus on providing seamless care and affordable benefits to small businesses.

US

Make outbound calls to schedule appointments for preventative health screenings. Assist members and patients with benefits and insurance information. Conduct surveys and make a difference in someone’s life!

Carenet Health has pioneered advancements for an experience that touches all points across the healthcare consumer journey.

US

Perform pre-call analysis and check the status by calling the payer or using IVR or web portal services. Maintain adequate documentation on the client software to send the necessary documentation to insurance companies. Comply with all reimbursement and billing procedures for regulatory, third party, and insurance compliance norms.

You’ll help connect providers, patients and communities with innovative solutions that create real value by supporting both the financial and clinical sides.

  • Support patients through the denial and appeal process.
  • Coordinate with healthcare providers and insurance companies.
  • Ensure seamless access to our innovative DME device.

Noctrix Health is redefining the treatment of chronic neurological disorders with clinically validated therapeutic wearables. Their team is dedicated to delivering prescription-grade therapy with an outstanding user experience and has pioneered the world’s first drug-free wearable therapy.

16w maternity

  • Responsible for collections and appeals from various Federal, State, & Third Party (HMO, PPO, IPA, TPA Indemnity) payers.
  • Optimize payment reimbursements by reviewing accounts for billing accuracy and health plan coverage.
  • Process an appeal, resubmit/rebill, or forward claims for adjudication as necessary.

BillionToOne is a next-generation molecular diagnostics company on a mission to make powerful, accurate diagnostic tests accessible to everyone. Forbes recently named them one of America's Best Startup Employers for 2025, and they were awarded Great Place to Work certification in 2024.

$48,484–$52,000/hr
US

  • Provide support across our full customer base via various channels, addressing complex product and technical inquiries with accuracy and efficiency.
  • Guide customers on best practices for revenue cycle management, claims submission, payment processing, collections, and denial management within our platform.
  • Meet or exceed established performance metrics, including customer satisfaction, resolution time, and quality benchmarks; handle a high volume of inbound calls daily, ensuring timely and accurate responses to customer inquiries.

Tebra is the digital backbone for practice well-being, formed by the merging of Kareo and PatientPop. They aim to unlock better healthcare by helping independent practices bring modernized care to patients everywhere, serving over 100,000 providers.

  • Be the primary point of contact for all providers.
  • Provide professional, accurate and timely responses to all provider inquiries.
  • Maintain a current knowledge of all contract requirements and objectives.

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans.

$49,355–$49,355/hr

  • Coordinate care between VA and community providers.
  • Schedule appointments and coordinate care.
  • Process administrative notes for consults.

CVP is an award-winning healthcare and next-gen technology and consulting services firm solving critical problems for healthcare, national security, and public sector clients.

$29,566–$33,253/yr
Canada

  • Provide support and service to providers and members.
  • Effectively problem solve and contribute positively to a team environment.
  • Ensure the person making the inquiry receives the highest level of customer service possible.

Medavie is a national health solutions partner and innovative leader in healthcare delivery, benefits management, health management, and primary care. They have a team of 8,500+ professionals across Canada and are committed to improving the wellbeing of Canadians.