- LA Care Health Plan (Los Angeles, CA)
- Appeals & Grievances Regulatory Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, ... call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This… more
- Elevance Health (Los Angeles, CA)
- **Grievance & Appeals Analyst I** **Location:** Must be... analyst may serve as a liaison between grievances & appeals and /or medical management, ... essential face-to-face onboarding and skill development. The **Grievance & Appeals Analyst I** is an entry level...analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types… more
- Point32Health (MA)
- …general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible per State and Federal regulations ... responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for… more
- Motion Recruitment Partners (Durham, NC)
- Appeals Analyst Durham, North Carolina **100% Remote** Contract $20/hr - $25/hr Our client, a nationally recognized and award-winning company in the health ... insurance vertical, has a contract opening for a Appeals Analyst . They have over 4 million customers and 5,000+ employees dedicated to providing innovative… more
- ManpowerGroup (Durham, NC)
- …* Analyze, research, resolve and respond to confidential/sensitive appeals , coding disputes, grievances and coverage/organization determinations ... Our client is seeking Appeal Analyst a to join their team. Appeal ...benefit panels and external medical consultants. * Provide comprehensive appeals , coding disputes and grievances responses that… more
- Highmark Health (Columbus, OH)
- …they meet the definition of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals ; initiates a case file for each grievance ... parties. + Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross functional… more
- Sacramento Municipal Utility District (Sacramento, CA)
- …including writing defensible reports and disciplinary documents + Experience responding to grievances or appeals and serving as an employer representative in ... Title: Principal Employee Relations Analyst Department: Employee Relations Location: Sacramento, CA, US, 95827-3824 Category: **Minimum Pay Rate:** $123,531.20… more
- City and County of San Francisco (San Francisco, CA)
- …bargaining agreements. + Key duties include negotiating resolutions to grievances , investigating complaints of serious employee misconduct, and conferring with ... professional human resources experience, similar to 1241 Human Resources Analyst , in one or more of the following areas...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… more
- CenterLight Health System (NY)
- …efficiency. + Support stakeholders in claims appeals : review and track claims appeals and grievances , prepare reports, and provide status updates to ensure ... JOB PURPOSE: The Claim Analyst will play a pivotal role in enhancing the efficiency and effectiveness of the claims department by evaluating and refining processes,… more
- Evolent (Columbus, OH)
- …supporting Evolent's clinical services (ie, specialty care, utilization management, care management, appeals & grievances ) + Using analytical tools to integrate ... the mission. Stay for the culture. **What You'll Be Doing:** **Senior Analyst , Operational Analytics** The Operational Performance Analytics team, a part of… more
- City of Cincinnati (Cincinnati, OH)
- HUMAN RESOURCES ANALYST (GENERALIST) Print (https://www.governmentjobs.com/careers/cincinnati/jobs/newprint/4932310) Apply HUMAN RESOURCES ANALYST (GENERALIST) ... experience with collective bargaining agreements, corrective action, and grievance and appeals procedures; must be skilled in analyzing and investigating complaints,… more
- CVS Health (Springfield, IL)
- …building. + Coordinate with Network Management to issue provider CAP + Monitor Grievances according NCQA standards categories (3 grievances per QTR), including ... Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards * Excellent analytical… more
- Healthfirst (NY)
- …an at-a-glance view of key performance indicators (KPIs), member feedback based on appeals and grievances , utilization and spend across our Healthfirst products. ... + Creates visually appealing presentations that demonstrate data-driven insights to promote data driven decision making. + Builds a process to ensure the accuracy of our dental directory meets Healthfirst performance targets and/or compliance standards. +… more
- State of Colorado (CO)
- …not eligible for overtime compensation. Department Contact Information Nicole Hartog, HR Analyst ###@state.co.us How To Apply Please submit an online application for ... providing coaching and/or developing corrective action plans. + Resolves informal grievances , reviews formal grievances , and resolves customer and employee… more
- The County of Los Angeles (Los Angeles, CA)
- …personnel in their unit and effectively recommending the adjustment of grievances and disciplinary problems. Other positions are assigned such functions as: ... first level technical and administrative supervision to the complaint or advanced-level appeals unit. Essential Job Functions + Supervises the activities of all… more