- Centene Corporation (Phoenix, AZ)
- …**Position Purpose:** Analyze and resolve verbal and written claims and authorization grievance / appeals from providers and members. Resolve all State inquires ... appeal decisions. + Act as subject matter expert regarding grievances and appeals . + Lead Appeals and Grievance Committee + Performs other duties as assigned… more
- Centene Corporation (Phoenix, AZ)
- …member and provider complaints, grievances and appeals + Maintain files on individual appeals and grievances + May coordinate the Grievance and Appeals ... High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals , claims or related managed care experience. Strong oral, written,… more
- Commonwealth Care Alliance (Boston, MA)
- …clinical, operations, pharmacy, dental, reporting, and member services. + Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator ... No **Essential Duties & Responsibilities** Processing of Grievances & Appeals : + Responsible for the progress of grievance... Appeals : + Responsible for the progress of grievance and appeal intervention and resolution. + Assure verbal… more
- Robert Half Accountemps (Los Angeles, CA)
- …guidelines for use by examiners or Participant Services Representatives. * Assist Appeals Coordinator with the preparation of Benefits Committee appeal cases. ... Los Angeles is in the immediate need of a Grievance & Appeals Specialist. The Grievance...2 years of experience as a Medical Claims Review Coordinator or in a similar role * Proficient in… more
- CVS Health (Sacramento, CA)
- …carrying a modified case load including but not limited to:-Research incoming electronic appeals , complaints and grievance to identify if appropriate for unit ... resource and reroute inappropriate work items that do not meet appeals , complaints and grievance criteria. + Research Standard Plan Design or Certification of… more
- Geisinger (Danville, PA)
- Job Summary Provides support in administration of the Appeals and Grievance process. Serves as a liaison between Members and the Plan with appeals regarding ... Health Plan and external entities, communicating with all entities involved throughout the appeals and grievance process. + Maintains strict compliance with all… more
- Roper St. Francis (Charleston, SC)
- …Day shift 8:00am-5:00pm** **Job Summary** **:** The Patient Relations & Legal Coordinator aids in complaints and grievances management as well as legal matters ... resolutions, receives & forwards compliments, issues acknowledgement letters, forwards grievance forms within the designated timeframe, assists with accreditation… more
- State of Minnesota (St. Paul, MN)
- …adherence to contract performance that includes administration and management, client appeals and grievance systems, enrollee and provider communications, member ... **Working Title: Managed Care Outcomes Coordinator ** **Job Class: Human Services Program Representative 2**...to be eligible for telework.** The Managed Care Outcomes Coordinator is responsible for managed care organization (MCO) performance… more