- Commonwealth Care Alliance (Boston, MA)
- …lines or medical setting preferred - Prior experience with service authorizations, grievances and appeals , scheduling medical appointments preferred - Ability to ... members and all those involved in CCA members' care. The Member Service Representative (MSR) is responsible to provide a best-in-class service experience to all… more
- AmeriHealth Caritas (Philadelphia, PA)
- …more about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances , this position is responsible for the ... complaints/issues to management + Monitors to ensure that all problems with appeals / grievances presented by plan members/participants are resolved in accordance… more
- Independent Health (Buffalo, NY)
- …responsible for the collection and review of medical records specific to quality complaints/ grievances and appeals as indicated in support of a high performing ... plan and physician network. The Clinical Reviewer will investigate quality complaints/ grievances and appeals , document research of initial coverage… more
- MTA (New York, NY)
- …and participate in monthly conferences with union representatives to discuss contract grievances and employee discipline appeals ; perform analytical review of ... Senior Labor Relations Representative Job ID: 12716 Business Unit: MTA Headquarters...Aug 15, 2025 Description JOB TITLE: Senior Labor Relations Representative DEPT/DIV: Labor Relations WORK LOCATION: 420 Lexington Ave… more
- Access Dubuque (Dubuque, IA)
- …to internal processing guidelines. + Assist in review and resolution of complaints, appeals and grievances as needed. + Complete all additional assigned projects ... Member Services Representative **Medical Associates** 1 Positions ID: o6fSxfwu Posted...Health Plans is looking for a **full-time Member Services Representative ** to join our team! **Who You Are:** +… more
- Fallon Health (Worcester, MA)
- …of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and ... assigning all incoming appeals and grievances...acknowledgement of the grievance/appeal, educating the member and/or member representative about the grievance/appeal, gathering all pertinent and relevant… more
- Humana (Tallahassee, FL)
- …Providers / Specialists, benefit coverages, authorizations, Provider claims inquiries, grievances and appeals , transportation needs, and pharmacy support. ... APPLICATION (PDF OR WORD FORMAT) As a Contact Center Representative 2, you will provide coverage for **Eastern Time...120 days of employment as an Inbound Contact Center Representative constitute an appraisal period. This Appraisal Period is… more
- Commonwealth Care Alliance (Boston, MA)
- …lines or medical setting preferred * Prior experience with service authorizations, grievances and appeals , scheduling medical appointments preferred * Ability to ... members and all those involved in CCA members' care. The Member Service Representative (MSR) is responsible to provide a best-in-class service experience to all… more
- State of Colorado (Limon, CO)
- …plans, and conducts performance evaluations; resolves informal staff and/or inmate grievances . Assigns tasks, monitors and inspects work progress and ensures ... pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness and...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
- State of Colorado (Golden, CO)
- …development training (as available) + Resolves informal staff grievances . Provide formal/informal performance feedback. Initiate progressive discipline, in ... for all youth + Responds to and resolves youth grievances + Act as first public contact with agency...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
- State of Colorado (Denver, CO)
- …professional development training (as available). Resolves informal staff grievances . Provide formal/informal performance feedback. Initiate progressive discipline, ... interventions for all youth. Responds to and resolves youth grievances . Act as first public contact with agency when...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
- Transdev (Dorchester, MA)
- …of internal policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances . + Understand legal requirements and ... + Manage the grievance process and provide comprehensive responses to complaints, grievances , and arbitrations that support the Company's decision and comply with… more
- UNC Health Care (Morrisville, NC)
- …updates or changes through the Policy Advisory Committee. Review and coordinate appeals and grievances services as applicable. Participate in the coordination ... : **Investigation and resolution of employee relations:** Maintain a representative caseload involving variety of complex employee relations issues, including… more
- City of New York (New York, NY)
- … and administer the contractual grievance process. Serve as Hearing Officer for grievances and disciplinary appeals . Represent the agency at hearings before the ... play a key role in managing internal labor relations investigations, union grievances , and collective bargaining agreements and engagement with Union Partners, and… more
- State of Colorado (Denver, CO)
- …inmate hours and pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness, and creates real life ... 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 (Sterling, CO)
- …procedures and security protocol. + Resolve informal staff and/or inmate grievances and initiating corrective/disciplinary action if needed + Ensure safe, code ... 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 (Golden, CO)
- …hygiene practice. Ensure that youth are provided confidential access to grievances , medical assistance and mental health assistance as needed/requested without staff ... 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 (Jefferson County, CO)
- …a minimum of two methods. + Addresses individual/family/guardian complaints and resolves grievances at the lowest level. + Provide nursing care in conjunction with ... if your application is eliminated. You will find the appeals process, the official appeal form, and how to...State Personnel Board (https://spb.colorado.gov/) website. + You or your representative must sign and submit the official appeal form… more
- State of Colorado (Golden, CO)
- …conflicts, investigates and problem solves internal and external complaints and grievances from staff, youth, family, and other customers. Scheduling of clinic ... if your application is eliminated. You will find the appeals process, the official appeal form, and how to...the State Personnel Board website. + You or your representative must sign and submit the official appeal form… more
- State of Colorado (Denver, CO)
- …and maintaining medical supplies for store rooms and examination rooms; + Coordinate grievances by logging and mailing back responses. Complete flow sheets of all ... 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
