- UHS (Riverside, CA)
- …Bachelor's preferred. Minimum 3 years' experience in Medical Management (Utilization Management, Appeals and Grievances , and/or Concurrent Review). Over 2 years ... the policy and procedures updates, as necessary. Support the Delegation Oversight Analyst in the development and validation of reports regarding audits, including… more
- Point32Health (Watertown, MA)
- …the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst is responsible per State and Federal regulations for ... responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for… more
- Point32Health (MA)
- …(https://www.point32health.org/) . **Job Summary** Under the general direction of the Manager, Appeals and Grievances the Supervisor, Appeals and ... requirements, will coordinate and provide leadership for the daily operations of the Appeals and Grievances department. The supervisor represents the Appeals … more
- Elevance Health (Cerritos, CA)
- …of clinical information. + The analyst may serve as a liaison between grievances & appeals and /or medical management, legal, and/or service operations and ... **Title: Grievance/ Appeals Analyst I** **Virtual:** This role...analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types… 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
- City and County of San Francisco (San Francisco, CA)
- …bargaining agreements. + Key duties include negotiating resolutions to grievances , investigating complaints of serious employee misconduct, and conferring with ... professional human resources experience, similar to 1241 Human Resources Analyst , in one or more of the following areas...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… more
- City and County of San Francisco (San Francisco, CA)
- …School District, or San Francisco City College, working within the Human Resources Analyst (1241) classification. San Francisco is a vibrant and dynamic city, on the ... boards and commissions and in meetings with other departments. 7. Responds to appeals or protests of human resources decisions and/or procedures; and prepares and… more
- City and County of San Francisco (San Francisco, CA)
- …or San Francisco City College, working within the 1244 Senior Human Resources Analyst classification. ABOUT THE CITY AND COUNTY OF SAN FRANCISCO: San Francisco is ... also in shaping the future of San Francisco. 1244 SENIOR HUMAN RESOURCES ANALYST (E10150) RECRUITMENT + Application Opening: July 14, 2025 + Application Deadline:… more
- CVS Health (Richmond, VA)
- …with heart, each and every day. **Position Summary** The Senior Network Relations Analyst is responsible for the accurate and timely validation and maintenance of ... responsible for reviewing claims data and information. The Senior Network Relations Analyst is responsible for monthly Access and Availability monitoring as required… more
- City of Stockton, CA (Stockton, CA)
- Supervising Human Resources Analyst Print (https://www.governmentjobs.com/careers/stockton/jobs/newprint/5012788) Apply Supervising Human Resources Analyst ... and motivated individual to fill the position of Supervising Human Resources Analyst in the Human Resources Department, Benefits Division. This is an At-Will… 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...data cleaning workflows. + Experience working in claims or appeals analytics. + Ability to communicate and translate technical… more
- LA Care Health Plan (Los Angeles, CA)
- …Solution Center Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This… more
- The County of Los Angeles (Los Angeles, CA)
- …personnel in their unit and effectively recommending the adjustment of grievances and disciplinary problems. Other positions are assigned such functions as: ... first level technical and administrative supervision to the complaint or advanced-level appeals unit. Essential Job Functions + Supervises the activities of all… more
- Commonwealth Care Alliance (Boston, MA)
- …schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and ... to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role in ensuring accurate, compliant, and timely reimbursements… more
