- Commonwealth Care Alliance (Boston, MA)
- …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 ... including provider listings in their areas. - Complete comprehensive appeal and grievance intakes. - Collaborate with the member to accurately document their appeal… more
- AmeriHealth Caritas (Philadelphia, PA)
- …of medical management authorizations.; + Research and Investigate member and/or provider appeals and grievance requests, including review of UM/claim denial ... system and documents, all correspondence with a member/participant, representative and/or a provider, related to an appeal or...Care environment + 1 to 3 years' experience in grievance / appeals environment required **The Ideal Person will… more
- Fallon Health (Worcester, MA)
- …us on Facebook, Twitter and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance ... standards, other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH… more
- Commonwealth Care Alliance (Boston, MA)
- …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 ... including provider listings in their areas. * Complete comprehensive appeal and grievance intakes. * Collaborate with the member to accurately document their appeal… more
- MTA (New York, NY)
- Senior Labor Relations Representative Job ID: 12716 Business Unit: MTA Headquarters Location: New York, NY, United States Regular/Temporary: Regular Department: ... Date Posted: Aug 15, 2025 Description JOB TITLE: Senior Labor Relations Representative DEPT/DIV: Labor Relations WORK LOCATION: 420 Lexington Ave FULL/PART-TIME FUL… more
- BrightSpring Health Services (Lexington, KY)
- …to Member and Provider issues. Refer all unresolved issues to the next level including grievance and appeals . + Actively market plan to new senior care partners ... Advantage is becoming Abilis Health Plan!* We are seeking a Sales Account Representative /Executive for our Signature Advantage Plan who will work with senior care… more
- Highmark Health (Buffalo, NY)
- …and member requests, received from Medical Management & Policy (MM&P) and Member Grievance Departments. * Responsible for management of Peer to Peer telephone line. ... timely receipt, review and assignment of all incoming physician reviewer referrals and appeals to ensure that NCQA, URAC, CMS, DOH, DOL and state specific regulatory… more
- Transdev (Dorchester, MA)
- …+ Research, compile, and prepare data for use in grievance hearings, arbitration proceedings, labor/management initiatives, collective bargaining negotiations, and ... Resources policies and governmental laws and regulations. + Manage the grievance process and provide comprehensive responses to complaints, grievances, and… more
- City of New York (New York, NY)
- …contractual issues that may arise with CFB employees. - Serve as the CFB's grievance representative and administer the contractual grievance process. Serve ... as Hearing Officer for grievances and disciplinary appeals . Represent the agency at hearings before the Office of Labor Relations and arbitration sessions at the… more
- New York State Civil Service (Albany, NY)
- …rules, regulations and case law. The incumbent serves as the Chancellor's representative in hearing appeals of disciplinary and contract grievances pursuant ... relations policy for classified service employees.- Serves as the University's representative in the administration of the grievance procedures (contract,… more
- State of Colorado (Denver, CO)
- …referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance with DOC Administrative ... 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
