- Optum (San Juan, PR)
- … and grievances. This position will communicate with appropriate parties regarding appeals and grievance issues, implications and decisions. In addition, analyze ... and identifies trends for all appeals and grievances. Primary Responsibilities: Manage... and grievances. Primary Responsibilities: Manage and resolve healthcare appeals work type in accordance with regulatory guidelines, client… more
- Sonder Health Plans, Inc. (Atlanta, GA)
- …limited to (benefits, PCP lookup, appointment setting, scheduling transportation, and documenting Grievance and/or appeals ). Follow up on resolution of inquiries ... and communicating to all parties involved, in a timely and professional manner. Attends Customer Service & staff training, as required. Assists and supports other Member Services Department staff, as needed. Maintains and keeps in total confidentiality, all… more
- High Desert Medical Group (Lancaster, CA)
- …scheduling transportation, and accepting any forms. Advise members of referral, denial, appeals and grievance processes. Serve as a liaison for patients ... High Desert Medical Group is seeking a full time Member Services Representative . This individual will be responsible for a variety of tasks that lead to a high level… more
- Point32Health (Watertown, MA)
- …Point32Health (https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
- LA Care Health Plan (Los Angeles, CA)
- …Required: At least 5 years of experience resolving health care eligibility, access, grievance and appeals issues, preferably in health services, legal services ... Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, US,… more
- CVS Health (Harrisburg, PA)
- …Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. Educates ... do it all with heart, each and every day. **Position Summary** Customer Service Representative is the face of Aetna and impacts members' service experience by manner… more
- CVS Health (Springfield, IL)
- …Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. Educates ... Service group. Responsibilities below include, but not limited to: Customer Service Representative is the face of Aetna and impacts members' service experience by… more
- BrightSpring Health Services (Louisville, KY)
- …to Member and Provider issues. Refer all unresolved issues to the next level including grievance and appeals . + Actively market plan to new senior care partners ... Our Company Signature Advantage Overview Seeking a Sales Account Representative /Executive for our Signature Advantage Plan who will work with senior care partners to… more
- Transdev (Readville, MA)
- …+ Research, compile, and prepare data for use in grievance hearings, arbitration proceedings, labor/management initiatives, collective bargaining negotiations, and ... Resources policies and governmental laws and regulations. + Manage the grievance process and provide comprehensive responses to complaints, grievances, and… more
- City of Stockton, CA (Stockton, CA)
- …in labor negotiations; provides strategic guidance to staff on disciplinary appeals , grievance /arbitration appeals and labor negotiations proposals. ... activities and recommends policy and procedural improvements. + May serve as a City representative at the bargaining table or serve as back up as assigned. +… more
- City and County of San Francisco (San Francisco, CA)
- …Duties: According to Civil Service Commission Rule 109, the duties specified below are representative of the range of duties assigned to this job code/class and are ... of understanding; implements pay provisions of arbitration awards, mediated and grievance settlements; and reviews, analyzes, and processes requests for special pay… more
- Commonwealth Care Alliance (Boston, MA)
- …including provider listings in their areas. * Complete comprehensive appeal and grievance intakes. * Collaborate with the member to accurately document their appeal ... or grievance concern by ensuring all necessary information to start...of concerns or complaints conveyed by members and their representative . * Conduct research to provide accurate and informed… more
- CUNY (New York, NY)
- …immigration. The Special Counsel serves as hearing officer of disciplinary and grievance proceedings and represents the College at higher levels of the disciplinary ... and grievance processes. The Special Counsel also serves as the...grievances and disciplinary proceedings as well as student disciplinary appeals ; advocates the College's position at appeal hearings. -… more
- State of Colorado (Greeley, CO)
- …team meetings in collaboration with CYSO III + Ensure that youth grievance policy and procedure are followed. Review of grievances to include investigation, ... the official appeal form, signed by you or your representative . This form must be delivered to the State...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Pueblo, CO)
- …and assistance in ensuring individual rights are protected, implementation of grievance processes, transition planning, and obtaining benefits as needed. + Assists ... Board or request a review by the State Personnel Director. You will find the appeals process, the official appeal form, and how to deliver it on the State Personnel… more
- State of Colorado (CO)
- …referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance with DOC Administrative ... the official appeal form, signed by you or your representative . This form must be delivered to the State...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
