- Harrison Gray Search and Consulting LLC (Clearwater, FL)
- …for escalations and program questions. Participate in formal responses to complaints, grievances , and appeals . Support product development and sales processes, ... providers, with transparency in reporting results, trends, and issues to senior management and clients. Manage relationships with Preferred Provider Organizations,… more
- Metropolitan Transportation Authority (New York, NY)
- …involving labor relations issues such as contract interpretation, disciplinary matter, medical appeals , Civil Service Law and matters affecting Authority-wide ... Civil Service Law, matters affecting authority-wide policy and procedures, and involuntary medical leave. Handles complex contractual grievances that may have… more
- Elevance Health (Columbus, GA)
- **Grievance/ Appeals Analyst Senior ** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... skill development. Shift hours: 8:00am - 4:30pm EST** The **Grievance/ Appeals Analyst Senior ** is responsible for reviewing,...analyzing, and processing complex pre service and post service grievances and appeals requests in the Enterprise… more
- Sharp HealthCare (San Diego, CA)
- …for the position, and employer business practices. **What You Will Do** This Senior Medical Director position provides critical management and oversight for ... to Plan policy as needed.Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify… more
- City and County of San Francisco (San Francisco, CA)
- …City and County of San Francisco is looking to bring on board multiple Senior Human Resources Analysts to help departments in hiring, supporting, and retaining a ... growth, the City offers excellent benefits that include: competitive salaries; medical , dental, and vision insurance; defined benefit retirement plan; deferred… more
- CVS Health (Richmond, VA)
- …we do it all with heart, each and every day. **Position Summary** The Senior Network Relations Analyst is responsible for the accurate and timely validation and ... Staff may be responsible for reviewing claims data and information. The Senior Network Relations Analyst is responsible for monthly Access and Availability… more
- CVS Health (Baton Rouge, LA)
- …**Position Summary** We are hiring a Senior Analyst to support the Complaint, Grievances and Appeals (CG&A) team. This position will play an important role ... supporting root cause corrective actions within the appeals space by maintaining existing and building new reporting on appeal volumes and patterns. This role will… more
- Tufts Medicine (Boston, MA)
- Tufts Medical Center is a world-renowned academic medical center that has been providing exceptional care across New England for over two centuries. Our ... School of Medicine and a leading research institution that conducts game-changing medical and health policy research. **Location: Hybrid at Tufts Medical … more
- City and County of San Francisco (San Francisco, CA)
- …Unified School District, or San Francisco City College, working within the 1244 Senior Human Resources Analyst classification. ABOUT THE CITY AND COUNTY OF SAN ... it is today, but also in shaping the future of San Francisco. 1244 SENIOR HUMAN RESOURCES ANALYST (E10150) RECRUITMENT + Application Opening: July 14, 2025 +… more
- Highmark Health (Richmond, VA)
- …through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as a resource for technical ... requests, and drug claim edits/prior authorizations. Clearly defines the medical necessity of non-formulary and prior authorization medication exception requests,… more
- CVS Health (Tallahassee, FL)
- … director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review, and provider appeals ... as needed. * Outward facing position to interact and collaborate with medical / physical professional associates, the local provider community, state regulatory… more
- Sharp HealthCare (San Diego, CA)
- …policy as needed. + Completes and/or supervises the completion of all clinical appeals and grievances . Collaborates with Customer Care Manager to identify trends ... **Shift End Time** California Physicians and Surgeons License - Medical Board of CA; Doctor of Medicine (MD) **Hours**...in grievances . Supervises the process for identifying Potential Quality Issues.… more
- Centene Corporation (Olympia, WA)
- …Conducts concurrent and retrospective reviews of claims and appeals , and resolves grievances related to medical quality of care. + Leads, develops, directs ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- Somatus (Mclean, VA)
- …the best version of themselves, including: + Subsidized, personal healthcare coverage ( medical , dental vision) + Flexible Paid Time Off (PTO) + Professional ... the Regulatory and Accreditation Team to ensure compliance with audits, complaints/ grievances , and adherence to contractual obligations and Service Level Agreements… more
- University of Colorado (Aurora, CO)
- …Rank-Associate Professor and Professor** **Description** **University of Colorado Anschutz Medical Campus** **Department: School of Medicine, Office of the Dean, ... on campus & community committees as directed by the Senior Associate Dean for Faculty and CWO. + Oversee...+ Address faculty concerns regarding professionalism, grievance procedures, and appeals processes and serve as a neutral party and… more
- CHS (Clearwater, FL)
- …client trust. * Investigates and participates in formal responses relating to complaints, grievances and appeals received by or applicable to PAS. Participates ... service, claims administration, is where submissions for payment/reimbursement/sharing from medical providers and covered individuals are reviewed, subject to cost… more
- MTA (New York, NY)
- …involving labor relations issues such as contract interpretation, disciplinary matter, medical appeals , Civil Service Law and matters affecting Authority-wide ... Civil Service Law, matters affecting authority-wide policy and procedures, and involuntary medical leave. Handles complex contractual grievances that may have… more
- Sacramento County (Sacramento, CA)
- …flexible spending account options for dependent care and unreimbursed dental and/or medical cost; and an employee assistance program (EAP). GENERAL BENEFITS: Most ... a pre-tax basis via payroll deduction, to pay for medical , dental or dependent care expenses. + DEPENDENT CARE...Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days… more
- Guardian Life (Bethlehem, PA)
- …contact for all assigned DSOs. Respond to provider inquiries, concerns, complaints, appeals and grievances within assigned timeframes. Collaborate across teams ... manage contracts and financial reimbursement rates with DSOs + Make presentations to senior -level management of DSOs + Identify and report to leadership team on… more
