- Optum (San Juan, PR)
- …teams in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances . This position will communicate with appropriate ... implications and decisions. In addition, analyze and identifies trends for all appeals and grievances . Primary Responsibilities: Manage and resolve healthcare … more
- Ultimate (Sacramento, CA)
- …Program, website, and self-service tools available online. Accurately record and refer appeals and grievances according to department protocols and procedures. ... Meet department standards related to performance and attendance. Manage difficult or emotional customer situations, respond promptly to customer needs, solicit feedback to improve service, respond to requests for service and assistance, and meet commitments.… more
- SUNSHINE ENTERPRISE USA LLC (Orange, CA)
- …point of contact within or outside the organization for inquiries related to grievances and appeals . Monitors incoming complaints via the Customer Service system ... will assist with specialized services relevant to the Grievance and Appeals Resolution Services (GARS) department. Position Summary: The successful candidate shall… more
- UPMC Senior Communities (Pittsburgh, PA)
- …improvement review processes, including concurrent, prospective and retrospective reviews, member grievances , provider appeals , and potential quality of care ... concerns. Provide expedited review and determination of medically pressing issues in accordance with the established policies of the Health Plan. Keep current with accepted standards and professional developments in the areas of quality improvement and… more
- Elevance Health (Indianapolis, IN)
- …Law Enforcement). Assists and participates in appeal or fair hearings, member grievances , appeals , and state audits. Minimum Requirements: BA/BS degree and ... a minimum of 2 years of experience working with a social work agency; or any combination of education and experience which would provide an equivalent background. Preferred Skills, Capabilities and Experiences: Experience working with older adults in care… more
- CarolinasDentist (Raleigh, NC)
- …claims and balances; working problem EOBs, denials, and processing appeals as needed. Responsibilities Core Responsibilities: Reviews clinical note, x-rays, ... companies on claims issues and non-payments. Maintains and completes all appeals and requests from insurance companies Reviewing returned EOBs: Denials- manages… more
- Metropolitan Transportation Authority (New York, NY)
- …labor relations issues such as contract interpretation, disciplinary matter, medical appeals , Civil Service Law and matters affecting Authority-wide policy and ... policy and procedures, and involuntary medical leave. Handles complex contractual grievances that may have Authority-wide operations impact. Prepares schedules for… more
- Point32Health (MA)
- …(https://www.point32health.org/) . **Job Summary** Under the direction of the A&G Manager, the Appeals & Grievances QA Auditor audits the quality of letters and ... audit findings and identifies areas of opportunity for the A&G ( Appeals and Grievances ) department. Understands department, segment, organizational strategy… more
- Molina Healthcare (St. Petersburg, FL)
- …apply state level requirements to meet contract and regulatory expectations. * Establishes Appeals & Grievances department policies and procedures in line with ... and interprets trends and prepares reports that identify root causes for Appeals , Grievances , and Provider Disputes. Recommends and implements process… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA and other related quality program activities including: monthly case quality monitoring, coordination of… more
- Molina Healthcare (San Antonio, TX)
- …and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of the Appeals & Grievances unit that is responsible for reviewing and ... organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving...monitoring and training of local plans' provider dispute and appeals units to ensure adherence with Medicare standards and… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, ... achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Accounting/Finance Department: CSC Appeals & Grievances ... to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting the… more
- Point32Health (Watertown, MA)
- …responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for ... to organize, plan and implement the functions of Member Appeals and Grievances , maintain timelines and turnaround times to meet multiple requirements/regulations… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Coordinator I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Coordinator I supports the Customer Solution Center Appeals … more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, ... to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and… more
- Molina Healthcare (Omaha, NE)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. +… more
- Point32Health (MA)
- …(https://www.point32health.org/) . **Job Summary** Under the general direction of the Manager, Appeals and Grievances the Supervisor, Appeals and ... will coordinate and provide leadership for the daily operations of the Appeals and Grievances department. The supervisor represents the Appeals and … more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and ... as well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is… more
- Elevance Health (Tampa, FL)
- …or deny appeal and forwards to Medical Director for approval. + Ensures that appeals and grievances are resolved timely to meet regulatory timeframes. + ... + Utilizes leadership skills and serves as a subject matter expert for appeals / grievances /quality of care issues and is a resource for clinical and non clinical… more
