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1–2 jobs· newest first

Grievance & Appeals Nurse (Remote)New
Inland Empire Health Plan · Remote, US
$64K–$83KRemote · Full-time · Mid
Underwriter I
Capital Blue Cross · Harrisburg, US

+10K new in the last hour

Grievance & Appeals Nurse (Remote)

Inland Empire Health Plan · Posted Nov 9, 2026

Remote, United States
Remote
Full-time · Mid
$64K–$83K per year

2+ years

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The Grievance & Appeals Nurse works directly with IPAs, Hospitals, and internal departments to ensure grievance and appeal cases are processed according to policy, DMHC/DHCS/CMS regulations, and NCQA standards.

Compensation

USD $63,897.60 - USD $83,075.20 /Yr.

Responsibilities

Implement management of grievance and appeals cases ensuring compliance with state and federal guidelines
Ensure all team grievance and appeals cases are processed thoroughly and timely
Ensure all member grievance issues are investigated and care is coordinated appropriately
Work closely with Member Services, Provider Services, Compliance, Medical Services, and regulatory agencies
Review case coding for accuracy and assist in the resolution of member medical issues

Requirements

High school diploma or GED
Associate’s degree preferred
Nice to have: Experience in managed care setting
Nice to have: Experience in health care delivery setting

Skills

Case management Utilization management Active and unrestricted Vocational Nurse (LVN) license Knowledge of DMHC, DHCS, CMS, and NCQA regulations Written and verbal communication skills Microcomputer applications MedHOK Spreadsheet Database Word processing

Benefits

Competitive salary
Medical Insurance
Dental
Vision
Life insurance

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Underwriter I

Capital Blue Cross · Posted Nov 7, 2024

Harrisburg, Pennsylvania, United States
2+ years

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Responsible for pricing benefit plans, renewal underwriting, rate development, actuarial assignments, and financial contract approvals for Capital Blue Cross.

Responsibilities

Prepares rate quotations for prospective groups, benefit changes for current groups and rate renewals
Presents rate exceptions with analysis and recommendations
Consults with Sales, Sales Management and Underwriting Management
Supports Sales in justifying renewal calculations
Designs, modifies and programs minor applications for rating structures

Requirements

Bachelor's degree in mathematics, Finance, Statistics, Accounting or a related business field

Skills

Strong analytical skills Sound understanding of medical statistics Ability to abstract financial arrangements Effective communication in written and verbal format mainframe microcomputer applications

Benefits

Medical, Dental & Vision coverage
Retirement Plan
Paid Time Off
Holidays
Volunteer time off

See full job description