- Point32Health (MA)
- …responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for ... + Must be able to organize, plan and implement the functions of Member Appeals and Grievances , maintain timelines and turnaround times to meet multiple… more
- Sacramento Municipal Utility District (Sacramento, CA)
- …reports and disciplinary documents + Experience responding to grievances or appeals and serving as an employer representative in administrative hearings + ... serves as Substance Abuse Program Administrator and Designated Employer Representative (DER), providing day-to-day oversight to ensure compliance with applicable… more
- Concentrix (Albuquerque, NM)
- …their insurance related needs. Examples include: Inquiries regarding benefits, eligibility, appeals , grievances and troubleshooting medical devices. All while ... Job Title: Customer Service Representative (Healthcare) - Remote Job Description The Customer... (Healthcare) - Remote Job Description The Customer Service Representative (Remote) works from home and interfaces with customers… more
- Humana (Columbus, OH)
- …Providers / Specialists, benefit coverages, authorizations, Provider claims inquiries, grievances and appeals , transportation needs, and pharmacy support. ... in a best-in-class contact center. 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
- Humana (Madison, WI)
- …guidelines. + Actively participates in department/company meetings. + Manages complaints/ grievances / appeals and route appropriately for research and resolution. ... first** Humana/iCare is seeking a Call Center and Claims Representative to meet the needs of members, potential enrollees...other duties as assigned. The Call Center and Claims Representative works in a call center setting and provides… more
- CVS Health (Salem, OR)
- …claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals . + Initiates out-reach/welcome calls to ensure constituents ... heart, each and every day. **Position Summary:** Health Concierge -Customer Service Representative is the face of Aetna to provide targeted, personalized service… more
- TEKsystems (Harrisburg, PA)
- …inquiries or inform them of claim investigation outcomes. - Refer unresolved grievances , appeals , and claim resolutions to appropriate departments. - Maintain ... records of customer interactions and transactions. - Listen actively and probe callers to understand the purpose of their calls. - Research and communicate information regarding member eligibility and claim status. - Educate providers on claim submission… more
- CVS Health (Trenton, NJ)
- …claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals . + Initiates out-reach/welcome calls to ensure constituents ... expectations are met or exceeded. + Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase… more
- City of New York (New York, NY)
- …jurisdiction of the Department of Correction" - Investigate serious incidents - Review grievances from people in custody and staff - Evaluate the performance of the ... perform other duties as determined by the General Counsel. Appeals Under the Board's Minimum Standards, whenever DOC decides...requirement applies to you, please discuss with the agency representative at the time of interview. WORK LOCATION: 2… more
- State of Colorado (Denver, CO)
- …and guidance on issues that relate to performance management, progressive discipline, employee grievances and appeals , and civil rights. You will also be the ... 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 (CO)
- …providing coaching and/or developing corrective action plans. + Resolves informal grievances , reviews formal grievances , and resolves customer and employee ... complaints. Collaboration - + Acts as the DLO representative for assigned Region to organizations, government entities, and...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Denver, CO)
- …Quality and Standards Division within BHA and reports directly to the Grievances and Enforcement Manager. The Quality and Standards Division oversees the licensing ... on behalf of the BHA and receives and investigates grievances submitted to the BHA through complaints and critical...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
- State of Colorado (Chaffee County, CO)
- …Individualized Program Instruction/Tutoring, Multi-Disciplinary Staffing, Responding to Offender Grievances and Resolving Offender Issues, Offender Housing Placement ... hearings, ICC, Multi disciplinary staffing, vetting responses to offender grievances etc. Therefore, experience as an entry level officer...the official appeal form signed by you or your representative . This form must be completed and delivered to… more
- State of Colorado (Limon, CO)
- …and ensuring the completion of annual training. + Resolve conflict and informal grievances at the lowest level possible. + Ensure safe, efficient, compliant and cost ... 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 (Chaffee County, CO)
- …assigns tasks, inspects work and performs inmate evaluations and resolves inmate grievances ; reduces inmate idleness and creates real life work opportunities to ... 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 (Denver, CO)
- …actions, signing performance plans and appraisals, and resolving informal grievances . Positions start the hiring process, interview applicants, and recommend ... 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 (Canon City, CO)
- …include dental holds, special diets and work restrictions; + Respond to offender grievances ; + Participate in the daily dental clinic operations to include tool ... 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 (Denver, CO)
- …conflicts, investigates and problem solves internal and external complaints and grievances from staff, youth, family, and other customers. Scheduling of clinic ... 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 (Colorado Springs, CO)
- …at facilities and in lease space to include offender and personnel grievances , existing building conditions, building renovation plans and development of transition ... 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
- TAD PGS, Inc. (Chicago, IL)
- …employee grievance and disciplinary matters. + Oversees matters related to the Employee Appeals Board and acts as Representative of the Employee Appeals ... the implementation of policy and initiatives within the parameters of the CBA, grievances , arbitrations, the Family and Medical Leave Act, Affordable Care Act, and… more
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