- Elevance Health (Durham, NC)
- **Manager II Grievance /Appeals** **- Claims Support** **Office Locations:** _The selected candidate must reside within a reasonable commuting distance of the ... accommodation is granted as required by law._ The **Manager II Grievance /Appeals** responsible for management oversight of grievances and appeals departmental units… more
- Commonwealth Care Alliance (Boston, MA)
- …Processing of Grievances & Appeals: + Responsible for the progress of grievance and appeal intervention and resolution. + Assure verbal and written responses ... verbal and written correspondence. + Thoroughly document all member appeal and grievance related interactions and interventions into CCA database. Member Outreach: +… more
- Fallon Health (Worcester, MA)
- …and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance with CMS regulations, ... applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH Appeals and … more
- Centene Corporation (Phoenix, AZ)
- …Purpose:** Analyze and resolve verbal and written claims and authorization grievance /appeals from providers and members. Resolve all State inquires related to ... state and organizational regulations and policies and procedures + Review claim grievance for reconsideration and either approve/deny based on determination level or… more
- Robert Half Accountemps (Los Angeles, CA)
- …A Medical IPA Group in Los Angeles is in the immediate need of a Grievance & Appeals Specialist. The Grievance & Appeals Specialist, will be in responsible ... resolving denied claims, complying with State/Federal laws, rules, and guidelines. The Grievance & Appeals Specialist will be expected to perform research and… more
- Centene Corporation (Phoenix, AZ)
- …Maintain files on individual appeals and grievances + May coordinate the Grievance and Appeals Committee + Support the pay-for-performance programs, including data ... High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals, claims or related managed care experience. Strong oral,… more
- Commonwealth of Pennsylvania (PA)
- …and arbitrators to deal with problems and issues related to grievance administration. Additional responsibilities include: + Administering and implementing the ... submitted by labor organizations. Participates in meetings, interviews, and grievance hearings with labor and management parties in order...parties in order to evaluate the merits of the grievance based on contractual language and the facts of… more
- Transdev (North Las Vegas, NV)
- …ensure consistency in language and interpretation of collective bargaining agreements, grievance management, and arbitration preparation. Transdev is proud to offer: ... + Research, compile, and prepare data for use in grievance hearings, arbitration proceedings, labor/management initiatives, collective bargaining negotiations, and… more
- Point32Health (Watertown, MA)
- …. **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst is responsible per State ... and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with… more
- Molina Healthcare (San Antonio, TX)
- …Summary** Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member ... provider dispute/appeals processing. * Establishes member and non-contracted provider grievance /dispute and appeals policies/procedures and updates annually or as… more
- LA Care Health Plan (Los Angeles, CA)
- …manner. Coordinates, tracks, and resolves internal and external appeal and grievance complaints for LA Care Plan Partners, including identifying opportunities for ... improvement. Ensures timely appeal and grievance reporting to regulatory agencies, internal Regulatory Affairs and...Management) to ensure the use of appropriate appeal and grievance issue codes, timely resolution, and refers to community… more
- CareFirst (Baltimore, MD)
- …Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and determination of next steps for Government Program lines of ... and analyze all pertinent information in preparation of an appeal and/or grievance request. Access the appropriate database to implement accurate and timely entry… more
- Ventura County (Ventura, CA)
- …corrective actions while adhering to labor laws and regulations, and the grievance process, ensuring strict adherence to contract provisions and consistency in ... relations laws. + Advises departments and agencies on disciplinary actions, grievance procedures, recommends appropriate discipline levels, and prepares notices and… more
- HCA Healthcare (Round Rock, TX)
- …you will support the patient safety department in the maintenance of the grievance process, the patient safety event surveillance system to improve patients and ... and trend data on patient grievances utilizing the patient grievance and PSO tracking database. + You will monitor...and PSO tracking database. + You will monitor patient Grievance responses and investigate delayed responses as appropriate +… more
- CareFirst (Baltimore, MD)
- …Appeals Specialist II will be responsible for the initial analysis of appeals/ grievance correspondence, and determination of next steps, with minimal supervision for ... Actively participates in monthly meetings and discussions regarding quality appeal and/or grievance research, data entry and to problem solve any issues regarding… more
- CVS Health (Sacramento, CA)
- …load including but not limited to:-Research incoming electronic appeals, complaints and grievance to identify if appropriate for unit based upon published business ... reroute inappropriate work items that do not meet appeals, complaints and grievance criteria. + Research Standard Plan Design or Certification of Coverage (Evidence… more
- University of Southern California (Los Angeles, CA)
- …for Auxiliary Services employees. This role will manage labor relations and grievance processes to ensure that the university adheres to legal, compliance, ... and/or labor relations. + Extensive knowledge of collective bargaining, grievance processes, contract negotiation, contract administration and labor and management… more
- City of New York (New York, NY)
- …the Office of Tenancy Administration (OTA). OTA closely reviews termination and grievance cases to assist, where possible, with addressing curable breach cases, and ... - Review new, amended, and re-opened administrative termination and grievance cases to determine if they conform with procedures...Standard Procedures. - Ensure the submission of termination and grievance cases to the appropriate unit in the Law… more
- RTX Corporation (Tucson, AZ)
- …will administer and provide leadership and counsel on contract negotiation, grievance , arbitration, and federal and state labor legislation. This position also ... partners in support of represented employees and business operations. + Act as a grievance spokesperson for the company. Prepare for grievances in the final step of… more
- Fairfield Community School District (Fairfield, IA)
- …in its educational programs and its employment practices. There is a grievance procedure for processing complaints of discrimination. If you have questions or ... a grievance related to this policy please contact the district's...educational programs and its employment practices. There is a grievance procedure for processing complaints of discrimination. If you… more