Molina Healthcare
Specialist, Appeals & Grievances Remote
United States
Sponsorship not specifiedDetected 5 days ago
Research
About the role
- JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). Essential Job Duties • Facilitates
- comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. • Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. • Requests and reviews
Responsibilities
- Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes.
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This listing is sourced directly from Molina Healthcare's careers page and normalized into a canonical job model.