[Skip to main content](#main-content) [OpenNash Jobs](https://jobs.opennash.com/) [Hiring report](/reports/hiring/) · [All Molina Healthcare jobs](https://jobs.opennash.com/companies/molina-healthcare/) · [Search jobs](/search/) Molina Healthcare · FL, United States # Specialist, Appeals & Grievances (Claims) FL, United States Full-time Operations Listed on Molina Healthcare’s official careers site. Posted October 16, 2026. Check that it is still open and apply there. [Apply on Molina Healthcare’s careers site →](https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2039805) [OpenNash Jobs](https://jobs.opennash.com/) / [Molina Healthcare](https://jobs.opennash.com/companies/molina-healthcare/) / Specialist, Appeals & Grievances (Claims) ## 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 medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. - Meets claims production standards set by the department. - Applies contract language, benefits and review of covered services to claims review process. - Contacts members/providers as needed via written and verbal communications. - Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). - Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. - Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. - Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. ### Required Qualifications - At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. - Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. - Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. - Customer service experience. - Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. ### Preferred Qualifications - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. - Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). ### To all current Molina employees If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. ## At a glance - Posted by the employer: Oct 16, 2026 - First seen by OpenNash: Oct 18, 2026 - Last checked: Oct 18, 2026 - Listed for: 2 days - Location: FL, United States - Employment type: Full-time[Apply on Molina Healthcare’s careers site →](https://hckd.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_1/job/2039805) ## More jobs at Molina Healthcare ### [Analyst, Business - SQL (Remote in Florida)](https://jobs.opennash.com/companies/molina-healthcare/jobs/4c6949cea5c304835cc5/) FL, United States ### [Senior Examiner, Claims(Florida)](https://jobs.opennash.com/companies/molina-healthcare/jobs/e2da4e323d01766561d9/) FL, United States ### [Care Management Processor(Remote)-Must reside in Florida](https://jobs.opennash.com/companies/molina-healthcare/jobs/34bc9af0cc30b038eabf/) FL, United States ### [Care Manager - (RN, BH Licensed LCSW, LMHC, LMFT, LMSW) Multiple Openings in FL](https://jobs.opennash.com/companies/molina-healthcare/jobs/26a37f98f15b7f65c90f/) FL, United States ## Similar jobs at other companies ### [Senior Pharmacy PA/Appeals Technician](https://jobs.opennash.com/companies/unitedhealth-group/jobs/1992fc0e0bb9164a7d78/) UnitedHealth Group · Sugar Land, Texas ### [Clinical Grievances RN - Remote in CA](https://jobs.opennash.com/companies/unitedhealth-group/jobs/ccc8856bbf1790c1e5ef/) UnitedHealth Group · Mesa, Arizona, United States +1 more ### [Appeals Specialist](https://jobs.opennash.com/companies/universal-health-services/jobs/6e7b3e888a62004f36f9/) Universal Health Services · LAS VEGAS, Nevada ### [Appeals Assistant](https://jobs.opennash.com/companies/universal-health-services/jobs/40f105da5a4da635dc9e/) Universal Health Services · RICHMOND, Virginia ### [Claims Assistant](https://jobs.opennash.com/companies/albertsons/jobs/a595c7bedc5086e7cd57/) Albertsons · Pleasanton, CA, United States OpenNash lists jobs from employers’ own careers sites and does not handle applications. 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