Jobs in the United States

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CP
Account Manager- SMB Business Sales
Cellco Partnership
East Northport, NY
- $33,500 to $59,000 USD / year
…commission. Planning to go above and beyond? Our commission program allows unlimited opportunity which could allow top earners to exceed compensation plans and compete for various sales…
Added just now
CP
Account Manager- SMB Business Sales
Cellco Partnership
Dedham, MA
- $37,000 to $64,000 USD / year
…commission. Planning to go above and beyond? Our commission program allows unlimited opportunity which could allow top earners to exceed compensation plans and compete for various sales…
Added 10 mins ago
SE
IT Project Manager - Fulltime - Tampa, FL
SUNSHINE ENTERPRISE USA LLC
Tampa, FL
- Full-time
IT Project Manager to manage and coordinate technical resources involved in the
Added 14 mins ago
UO
Procurement & Supply Program Manager
University of Colorado Denver
Boulder, CO
- $75,000 to $85,000 USD / year
The University of Colorado Boulder is searching for a Procurement and Supply Chain Program Manager! This role supports purchasing activities ranging from maintenance, repair and operations…
Added 14 mins ago
SG
Future Opportunities - Business Development Manager
Spire Global
Boulder, CO
- $34,986 USD / year
As a Business Development Manager with Spire's Space Services product portfolio, you will drive growth, expand market presence, and secure new business opportunities with strategic…
Added 17 mins ago
W
(USA) Store Manager - Supercenter
Walmart
JACKSBORO, TN
- $110,000 to $170,000 USD / year
…concerns researchingissues leveraging necessary resources for complex timesensitive requests reviewing company policies and procedures teaching and drivingconsistency in responsiveness and…
Added 18 mins ago
W
(USA) Licensed Vision Center Manager - Dual
Walmart
INDIAN LAND, SC
- $39 to $52 USD / hour
…safety protocols. Manages quality assurance processes, resolves complex optical issues under applicable optometric supervision, and maintains equipment calibration, cleanliness, and…
Added 18 mins ago
W
(USA) Store Manager - Supercenter
Walmart
MARYSVILLE, OH
- $110,000 to $170,000 USD / year
…concerns researchingissues leveraging necessary resources for complex timesensitive requests reviewing company policies and procedures teaching and drivingconsistency in responsiveness and…
Added 18 mins ago
W
USA) Operations Manager, Procurement
Walmart
LANCASTER, TX
- $84,000 to $126,000 USD / year
…Present to and influence teams customers and clients conveying complex information clearly accurately and addressing ambiguity in a constructive manner Independently assemble and prepare…
Added 18 mins ago
W
Licensed/Registered Vision Center Manager - Single
Walmart
POMONA, CA
- $37 to $50 USD / hour
…safety protocols. Manages quality assurance processes, resolves complex optical issues under applicable optometric supervision, and maintains equipment calibration, cleanliness, and…
Added 18 mins ago
W
(USA) Store Manager - Division 1/Neighborhood Market
Walmart
ROGERS, AR
- $95,000 to $145,000 USD / year
Added 18 mins ago
W
(USA) Store Manager - Supercenter
Walmart
HAZLEHURST, MS
- $110,000 to $170,000 USD / year
…concerns researchingissues leveraging necessary resources for complex timesensitive requests reviewing company policies and procedures teaching and drivingconsistency in responsiveness and…
Added 18 mins ago
W
Area Manager - Floor-2
Walmart
PEDRICKTOWN, NJ
- $65,500 to $98,000 USD / year
Live Better U is a Walmart-paid education benefit program for full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high school completion to…
Added 19 mins ago
W
(USA) Licensed/Registered Vision Center Manager - Single
Walmart
WILMINGTON, NC
- $41 to $54 USD / hour
…safety protocols. Manages quality assurance processes, resolves complex optical issues under applicable optometric supervision, and maintains equipment calibration, cleanliness, and…
Added 19 mins ago
W
(USA) Store Manager - Supercenter
Walmart
NASHVILLE, TN
- $110,000 to $170,000 USD / year
…concerns researchingissues leveraging necessary resources for complex timesensitive requests reviewing company policies and procedures teaching and drivingconsistency in responsiveness and…
Added 20 mins ago
W
(USA) Pharmacy Manager, Store # 01483
Walmart
YANKTON, SD
- $112,000 to $197,000 USD / year
Added 20 mins ago
W
(USA) Senior Manager, People
Walmart
BENTONVILLE, AR
- $90,000 to $180,000 USD / year
Extensive experience in human resource management and organizational development within complex business environments.
Added 20 mins ago
W
(USA) Staff, Product Manager - WMC Data Foundation
Walmart
BELLEVUE, WA · HOBOKEN, NJ
- $132,000 to $264,000 USD / year
As a Staff Product Manager, you will lead strategy and execution for complex products, driving end-to-end outcomes from discovery through value realization. This role requires deep…
Added 20 mins ago
W
(USA) Manager, Data Analytics
Walmart
BENTONVILLE, AR
- $80,000 to $155,000 USD / year
Analyze complex datasets to identify trends, risks, and value opportunities that support sourcing and business objectives.
Added 20 mins ago
W
(USA) Licensed Vision Center Manager - Dual
Walmart
MORAINE, OH
- $32.5 to $45.5 USD / hour
…safety protocols. Manages quality assurance processes, resolves complex optical issues under applicable optometric supervision, and maintains equipment calibration, cleanliness, and…
Added 20 mins ago
W
(USA) Senior Manager, Operations
Walmart
BENTONVILLE, AR
- $90,000 to $180,000 USD / year
Proven expertise in operations and project management with the ability to lead complex initiatives and manage multiple work streams.
Added 21 mins ago
W
Senior Manager, Quality Assurance Ops Excellence and Resiliency
Walmart
BENTONVILLE, AR
- $90,000 to $180,000 USD / year
…resilience, business continuity, technology transformation, program management, risk operations, or related…
Added 21 mins ago
W
(USA) Senior Manager, Technology Operations
Walmart
BENTONVILLE, AR
- $90,000 to $180,000 USD / year
The Senior Manager, Technology Operations, leads the planning and execution of multiple complex technology programs aligned with strategic objectives. This role requires expertise in…
Added 21 mins ago
W
(USA) Principal, Technical Program Manager
Walmart
BENTONVILLE, AR
- $110,000 to $220,000 USD / year
Walmart is seeking a Principal, Technical Program Manager to lead complex, large-scale technology programs with cross-functional dependencies. This role requires expertise in program…
Added 21 mins ago
W
Manager, Process Improvement
Walmart
BENTONVILLE, AR
- $80,000 to $155,000 USD / year
The (USA) Manager, Process Improvement leads initiatives to enhance key business functions by analyzing performance data, identifying gaps, and developing sustainable solutions. This role…

GuideWell

Appeals & Grievances Coordinator

FL, United States

$20 to $33 USD / hour

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Job details

Pay: $20 to $33 USD / hour
Experience: 3+ years related work experience in experience in Member Contact, Enrollment, Maintenance and Billing (EM&B), Claims or Medicare experience.
Posting language: English
Posted: Nov 4, 2026

Original job description

We seek contributors who deliver results with accountability while collaborating seamlessly across boundaries. They embrace change with resilience, staying curious and learning continuously in a rapidly evolving landscape. Grounded in business understanding and comfortable with AI and digital tools, they solve problems with critical thinking and creativity. Above all, they are driven to serve - ensuring their work creates meaningful impact for members and the community we support.

The primary responsibilities of a Medicare Appeals and Grievances Coordinator are centered on daily resolution of Medicare member, member's representatives (which can be a treating physician) and non-participating provider's appeals and grievances in compliance with applicable CMS timeframes and regulations. The Medicare Appeals & Grievances Coordinator is accountable for inventory prioritization of case load to meet various CMS and OIR required SLAs, gathering applicable information related to the case, working with appellants and delegated vendors to obtain for medical records, tracking effectuations, and meeting strict written and oral notification requirements.

What You Will Be Doing

Review appeal and grievance cases from various appellant types (member, member representative, treating physician and non-participating providers) in accordance with CMS regulatory guidelines and timeframes.
Must ensure cases are classified correctly and reviewed for potential expedited requests.
Resolves complex standard or expedited grievances, appeals or disputes involving expressions of dissatisfaction, reimbursement, medical necessity,
Utilization Management and benefits from the various appellant types (member, member representative, treating physician and non-participating providers) in accordance with CMS regulatory guidelines and timeframes.
Prioritize case workload to ensure CMS timeframes and required written notifications are met for various case types:
Standard Pre-Service Appeals
Expedited Pre- Service Appeals
Post Service appeals
Payment Disputes
MA Grievances
Med Supp Grievances
Access various systems such as: MAAGC, JIVA, Diamond, ProviderConnect, Client Letter, ERCMS RADMD, Magellan, and Blue 2 in order to gather pertinent data related to the case and document resolution.
Conduct a thorough research and accurately document pertinent details to include research details, action taken for resolution or outreach to various business partners and attach supporting documents to the case
Coordinates with internal business partners and provides case details, gathers required data or medical records for cases related to clinical decisions, delegated vendors, claims, network, etc.
Ensure proper research is completed with documentation of supporting details to render a final determination with verbal and/or written notification to the appellant within the CMS timeframes
Perform outreach to members, providers, internal and external business partners in order to complete resolution of appeal or grievance
Facilitates escalated calls and issues from providers and/or members regarding appeals or dispute decisions. Escalates any issues or phone calls to the Manager as needed.

What We Require

3+ years related work experience in experience in Member Contact, Enrollment, Maintenance and Billing (EM&B), Claims or Medicare experience. High school diploma or GED
Additional Required Qualifications
Experience using Siebel, Diamond, JIVA and other Medicare databases.
Ability to work flexible schedule with overtime and weekends when needed
Medicare product knowledge
Ability to work independently and collaboratively as a team member
Excellent interpersonal skills and an ability to recognize, understand, and respond to sensitive member issues or concerns
Ability to manage multiple priorities, have analytical and problem solving skills with attention to detail

What We Prefer

Bachelor’s degree
Strong working knowledge of Medicare Advantage/ Supplement/ Frozen Products, CMS, OIR, DFS and other regulatory requirements
Proven organizational skills with strong attention to detail
Proven ability to work independently, collaboratively and use appropriate judgment to make independent decisions by following guidelines Intermediate PC skills (MS Word, Excel, PowerPoint) Hands-on experience processing Medicare Claims, Written Inquiries or EMB transactions
Current Experience with JIVA, Diamond, ProviderConnect, CustomerConnectClient Letter, ERCMS RADMD, Magellan, and Blue 2

General Physical Demands

Exerting up to 10 pounds of force occasionally to move objects.
Jobs are sedentary if traversing activities are required only occasionally.
Team schedules are determined based on role requirements and business needs. Travel to and from our corporate offices may be required.

What We Offer

As a Florida Blue employee, you will be at the heart of GuideWell’s vision – to lead the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

Medical, dental, vision, life and global travel health insurance
Income protection benefits: life insurance, short- and long-term disability programs
Leave programs to support personal circumstances
Retirement Savings Plan including employer match
Paid time off, volunteer time off, 10 holidays and 2 well-being days
Additional voluntary benefits available; and a comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases. Typical Hourly Offer/Pay Range: $20 - $25

Hourly Pay Range: $20 - $33

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.

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More about this job

Skills

Critical thinking
CMS
Research
Documentation
Product knowledge
Work independently
Interpersonal skills
Problem solving
Attention to detail
Organizational skills
Microsoft Word
Microsoft Excel
Microsoft PowerPoint

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