- Robert Half Accountemps (Los Angeles, CA)
- Description A Medical IPA Group in Los Angeles is in the immediate need of a Grievance & Appeals Specialist . The Grievance & Appeals Specialist , ... denied claims, complying with State/Federal laws, rules, and guidelines. The Grievance & Appeals Specialist will be expected to perform research 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 Grievances ... 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
- TEKsystems (Baltimore, MD)
- … background ! Description Job Profile Summary: The Grievance and Appeal Intake Specialist supports the Appeals and Grievance (A&G) function by handling ... TekSystems is currently hiring for a FULLY REMOTE Grievance and Appeal Intake Specialist ! This...Work involves a review of recorded calls relating to appeals and grievances and prepares written transcripts, as appropriate.… 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 ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist ...This position will focus on quality review of non-clinical grievance and appeals cases for all line… 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, CA, ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- Molina Healthcare (Omaha, NE)
- …hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing and resolving member ... appeals and communicating resolution to members and provider (or...and grievances using support systems to determine appeal and grievance outcomes. + Requests and reviews medical records, notes,… more
- LA Care Health Plan (Los Angeles, CA)
- … Appeals and Grievances Coordinator I supports the Customer Solution Center Appeals & Grievance Specialists by handling the administrative functions of the ... required by clinical staff to render decisions, assists the Customer Solution Center Appeals & Grievance Manager and Director in meeting regulatory timelines by… more
- Commonwealth Care Alliance (Boston, MA)
- …& Responsibilities:** + Conduct monthly case review of a random sample of appeals and grievance cases against previously developed scorecard and Federal and ... 011540 CCA- Appeals & Grievances **Position Summary:** Appeals ...+ Communicate and work collaboratively with AG Representatives, Resolution Specialist and Management to maintain and improve quality of… more
- Department of State - Agency Wide (Washington, DC)
- …applicants who respond to this flyer. Responsibilities As a Human Resource Specialist (Employee Relations) at a minimum you will ensure the effective administration ... approach to reported misconduct. Reviews grievances in accordance with the administrative grievance policy and determines whether or not the grievance meets… more
- Department of State - Agency Wide (Washington, DC)
- …applicants who respond to this flyer. Responsibilities As a Human Resource Specialist (Employee Relations) at a minimum you will ensure the effective administration ... approach to reported misconduct. Reviews grievances in accordance with the administrative grievance policy and determines whether or not the grievance meets… more
- Walworth County (Elkhorn, WI)
- Disability/Elder Benefit Specialist (HHS) Print (https://www.governmentjobs.com/careers/walworthco/jobs/newprint/5021485) Apply Disability/Elder Benefit ... or community Provide information on consumer rights, complaints, grievances and appeals processes and assistance in preparing and filing complaints, grievances and… more
- Navy Exchange Services (NEX) (Virginia Beach, VA)
- Title: Labor/Employee Relations Specialist I/ II/ III (Non-competitive Progression) Location: United States-Virginia-Virginia Beach Job Number: 250000Q1 Note: This ... Summary: Under the guidance and supervision of a Labor/Employee Relations Specialist or Labor/Employee Relations Manager, responsible for providing technical support… more
- Tufts Medicine (Boston, MA)
- …involving a variety of areas including employee discipline/corrective action and employee appeals and the grievance process. 2. Develops and modifies Employee ... union contract administration including the investigation of grievances, drafting grievance responses, MOA preparation. 6. Coordinates and prepares information for… more
- Johns Hopkins University (Baltimore, MD)
- …actions and make sound recommendations to management. + Manage the grievance process, including fact finding, reviewing evidence, serving as hearing officer, ... as an advisor to employees and management on employee appeal and grievance issues. + Work in partnership with department management regarding appropriate… more
- State of Colorado (CO)
- …referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance with DOC Administrative ... of the department's action. For more information about the appeals process, the official appeal form, and how to...position, please direct your inquiries to our Employee Relations Specialist , Kristen Lange , at doc_###@state.co.us or call ###… more
- Elevance Health (Los Angeles, CA)
- …necessity determinations for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures ... a health profession. **Preferred skills, capabilities, and experiences:** + Oncology specialist preferred + Internal medicine specialist preferred For candidates… more