- Monster (New York, NY)
- …mentorship, and high performance. Position Overview We are seeking a motivated Associate Attorney to join our Workers' Compensation team. You'll represent insurance ... Compensation Board Conduct depositions of IME and treating physicians Draft appeals , rebuttals, and summations Develop negotiation strategies and settle claims… more
- Monster (Anchorage, AK)
- …matters, including bid protests (GAO, COFC), contract claims and appeals , terminations, and litigation strategy. Collaborate cross-functionally to develop risk ... mitigation strategies and ensure contractual obligations are properly managed. Interact with external counsel, government contracting officers, and regulator agencies as needed. Oversee outside counsel and litigation. Perform other duties as assigned by the… more
- Monster (Atlanta, GA)
- …aspects of the drinking and wastewater systems, including billing support and appeals , collections, contracts, real estate, and land use. This position includes ... supporting the legal needs of the state's largest water and wastewater utility, the Department of Watershed Management; the world's busiest airport, Hartsfield-Jackson Atlanta International Airport; and the City's Office of Sustainability and Resilience.The… more
- Monster (Houston, TX)
- Gonzalez Olivieri LLC immigration is looking for an associate attorney to practice at our office in Houston, Texas. The position is available for immediate hire and ... and practice immigration law before USCIS, immigration courts, and all courts of appeals . Prior experience in immigration law is a requirement. The attorney must be… more
- CVS Health (Hartford, CT)
- …Qualifications** - Utilization Review experience - Medicare experience - Managed Care Appeals experience **Education** Associate 's degree or RN diploma required ... occasional weekends and holidays on a rotation schedule. The Appeals Nurse Consultant position is responsible for processing the...for processing the medical necessity of Medicare Part C appeals from both members and providers. This role is… more
- CVS Health (Hartford, CT)
- …+ Managed Care experience + Utilization Management experience + Coding experience + Appeals experience **Education** + Associate 's Degree minimum OR Diploma RN ... business hours 8a-5p in time zone of residence Monday - Friday. The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare… more
- Molina Healthcare (Austin, TX)
- …systems and other available resources. + Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines. + ... Determines appropriate language for letters and prepare responses to appeals and grievances. + Elevates appropriate appeals ...to appeals and grievances. + Elevates appropriate appeals to the Appeals Specialist. + Generates… more
- Hawaiian Electric (Honolulu, HI)
- …on all aspects of litigation matters from case inception to judgment and appeals . SENIOR ASSOCIATE GENERAL COUNSEL (LITIGATION & REGULATORY) JOB FUNCTION: ... Associate General Counsel or Senior Associate ...property damage claims, from case inception to judgment and appeals ; advising officers, managers and employees regarding proposed legislation,… 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 team ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… 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, US, ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- State of Minnesota (St. Paul, MN)
- …this position.** One (1) year* of experience processing claims and/or appeals . * Associate 's degree in Business Administration, Public Administration, Community ... Development, Economics, Human Resources, or other closely related field as determined by the agency may substitute six (6) months of experience; bachelor's degree substitutes for one (1) year of experience; master's degree substitutes for eighteen (18) months… more
- Point32Health (MA)
- …. **Job Summary** Under the direction of the A&G Manager, the Appeals & Grievances QA Auditor audits the quality of letters and keyed ... entries from the Grievance and Appeals systems. Checks cases built by other associates to...findings across colleagues or repeating findings with a specific associate . Root cause analysis may be performed to identify… more
- Centene Corporation (Indianapolis, IN)
- …cases ( provider Retro cases)** **Education/Experience:** High school diploma or equivalent. Associate 's degree preferred. 2+ years grievance or appeals , claims, ... **Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.… 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 Appeals & ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting… more
- Humana (San Juan, PR)
- …our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties that require… more
- Commonwealth Care Alliance (Boston, MA)
- …supports the review data for completeness and accuracy. **Required Education:** + Associate 's Degree or equivalent experience in Appeals and Grievances **Desired ... 011540 CCA- Appeals & Grievances **Position Summary:** Appeals ...Education:** + Bachelor's Degree (BS or BA) or an Associate 's Degree with equivalent of at least 2 years… more
- New York State Civil Service (Garden City, NY)
- …Agency Court Administration, Office of Title Attorney Series, Special Litigation and Appeals (# 52559) Occupational Category Legal Salary Grade 31 Bargaining Unit ... by the Deputy Chief Attorney in charge of Special Litigation and Appeals from this docket, which will involve: in-depth legal research; drafting high-quality… more
- Humana (Charleston, WV)
- …our caring community and help us put health first** The Grievances & Appeals Representative 2 manages client denials and concerns by conducting a comprehensive ... with clinical and other Humana parties. The Grievances & Appeals Representative 2 performs varied activities and moderately complex… more
- CVS Health (Hartford, CT)
- …do it all with heart, each and every day. **Position Summary** The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare ... Part C appeals from both members and providers. This role is...Experience + Utilization Review + Medicare Experience **Education** + Associate 's Degree in Nursing required + Bachelor's Degree preferred… more
- CVS Health (Columbus, OH)
- …care for members. Administers review and resolution of clinical complaints and appeals . Interprets data obtained from clinical records to apply appropriate clinical ... experience, including hospital acute care/medical experience. + 1+ years of Appeals experience in Utilization Management + 3+ years utilization review experience.… more
