- Area Agency On Aging 1-b (Southfield, MI)
- The Appeals and Grievance Specialist is responsible for managing and resolving appeals and grievances in accordance with contractual, regulatory, and ... filings, and in administrative hearing proceedings. Duties Include: + The Appeals and Grievance Specialist is responsible for managing and resolving … more
- Actalent (Dallas, TX)
- Job Title: Specialist , Appeals & GrievancesJob Summary: Responsible for reviewing and resolving member and provider complaints and communicating resolutions. Key ... Responsibilities: + Conduct comprehensive research and resolve appeals , disputes, grievances, and complaints. + Use internal systems to determine outcomes of claims … more
- LA Care Health Plan (Los Angeles, CA)
- …track all due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist .; submit all Grievances and Appeals ... Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the… more
- BayCare Health System (Clearwater, FL)
- …be working remotely?** Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Grievance Specialist -Health Plan **Location** Clearwater:Park Place | ... and medical records. + Triage, plan, and execute intake of Appeals and Grievance submissions. + Keeping track of deadlines, ensuring all necessary documentation… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC ... 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
- Molina Healthcare (IA)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance … more
- State of Colorado (Adams County, CO)
- Youth Services Specialist II - Prairie Vista Youth Services Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5093116) Apply Youth ... Services Specialist II - Prairie Vista Youth Services Center Salary...in collaboration with CYSO III + Ensure that youth grievance policy and procedure are followed. Review of grievances… more
- LA Care Health Plan (Los Angeles, CA)
- …remedial training to CSC staff on identified areas of improvement, such as Appeals and Grievance processes, Claims, etc. Through various delivery methods that ... Customer Solution Center Training Specialist II Job Category: Administrative, HR, Business Professionals...II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017… more
- Commonwealth of Pennsylvania (PA)
- …how service purchases are calculated, clarification of information received, complaints, grievance settlements, arbitration awards, appeals , and tax information ... Retirement Benefits Specialist Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5102641) Apply Retirement Benefits Specialist Salary… more
- Cedars-Sinai (CA)
- …CSHS employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process, etc. + Remains updated ... **Job Description** The Managed Care Compliance Specialist is responsible for assisting with the implementation...ID** : 11981 **Working Title** : Managed Care Compliance Specialist - Managed Care **Department** : MNS Managed Care… more
- State of Colorado (Chaffee County, CO)
- …providing opportunities for inmates to receive feedback, crisis intervention, and grievance resolution; + Stress results oriented direction in guiding inmates ... 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 ###. ALL… more
- State of Colorado (Pueblo, 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