- LA Care Health Plan (Los Angeles, CA)
- …Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider complaints and ... Customer Solution Center Appeals and Grievances Specialist ...experience in Managed Care with specific experience in resolving member and provider complaint and appeals issues,… more
- Molina Healthcare (Omaha, NE)
- …Appeals and IRE experience** **Job Summary** Responsible for reviewing and resolving member appeals and communicating resolution to members and provider (or ... + Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers… more
- Molina Healthcare (Caldwell, ID)
- …to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine Provider No Surprises ... benefits, and review of covered services + Responsible for contacting the member /provider through written and verbal communication. + Prepares Provider No Surprises… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA...+ Communicate and work collaboratively with AG Representatives, Resolution Specialist and Management to maintain and improve quality of… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and ... Communicate and work collaboratively with CCA departments to help manage and resolve member appeals and grievances . + Act as a liaison between multiple… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist II will be responsible for the initial analysis of appeals /grievance correspondence, and ... collecting, organizing and tracking information to facilitate and expedite processing of appeals / grievances received from a variety of sources. Responsible for… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and ... and tracking information to facilitate and expedite processing of appeals and/or grievances received from a variety...breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit… more
- LA Care Health Plan (Los Angeles, CA)
- …Center Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: ... call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This… more
- Walworth County (Elkhorn, WI)
- …contact, in home or community Provide information on consumer rights, complaints, grievances and appeals processes and assistance in preparing and filing ... Disability/Elder Benefit Specialist (HHS) Print (https://www.governmentjobs.com/careers/walworthco/jobs/newprint/5021485) Apply Disability/Elder Benefit...complaints, grievances and appeals at the local, state… more
- State of Colorado (CO)
- CDOC - Human Resources Specialist V (Human Resources Manager) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4994350) Apply CDOC - Human ... Resources Specialist V (Human Resources Manager) Salary $7,610.00 - $12,177.00...Defined + Contribution Plan plus 401K and 457 plans. Member Contribution Rates . Correctional Officers I-IV qualify as… more
- State of Colorado (Aurora, CO)
- CDOC - Community Programs Specialist III (Re-Entry) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5021171) Apply CDOC - Community Programs ... Specialist III (Re-Entry) Salary $4,906.00 - $7,849.00 Monthly Location...Defined + Contribution Plan plus 401K and 457 plans. Member Contribution Rates . Correctional Officers I-IV qualify as… more
- Tufts Medicine (Boston, MA)
- …a variety of areas including employee discipline/corrective action and employee appeals and the grievance process. 2. Develops and modifies Employee Relations ... 5. Provides union contract administration including the investigation of grievances , drafting grievance responses, MOA preparation. 6. Coordinates and prepares… more
- TEKsystems (Reston, VA)
- Description PURPOSE: The Appeals Specialist II will be responsible for the initial intake analysis of appeals / grievances correspondence and determination ... claims to assist medical professional staff in performing the review of appeals grievances and reconsiderations. Prioritize research analyze and perform accurate… more
- Commonwealth Care Alliance (Boston, MA)
- …schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and ... are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental… more
- State of Colorado (Denver, CO)
- …Defined Benefit Plan or PERA Defined + Contribution Plan plus 401K and 457 plans. Member Contribution Rates . + Medical and dental health plans; + Short and long ... DOC departments; + Responsible for budget, reporting, conflict resolution, inmate grievances , and maintaining a comprehensive inmate medical record; + Responsible… more
- State of Colorado (Sterling, CO)
- …Benefit Plan or PERA Defined + Contribution Plan plus 401K and 457 plans. Member Contribution Rates . Correctional Officers I-IV qualify as "Safety Officers" and are ... plans, and conducts performance evaluations; resolves informal staff and/or inmate grievances . Assigns tasks, monitors and inspects work progress and ensures… 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
- State of Colorado (Colorado Springs, CO)
- …Benefit Plan or PERA Defined + Contribution Plan plus 401K and 457 plans. Member Contribution Rates . Correctional Officers I-IV qualify as "Safety Officers" and are ... 5 Budget Analysts, including conducting necessary corrective actions, performance plans, grievances , interviewing, and hiring; + Work in conjunction with the Office… more
- State of Colorado (Limon, CO)
- …Benefit Plan or PERA Defined Contribution Plan plus 401K and 457 plans. Member Contribution Rates . Correctional Officers I-IV qualify as "Safety Officers" and are ... completion of annual training. + Resolve conflict and informal grievances at the lowest level possible + Ensure safe,...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)
- …Benefit Plan or PERA Defined + Contribution Plan plus 401K and 457 plans. Member Contribution Rates . Correctional Officers I-IV qualify as "Safety Officers" and are ... hours and pay, creates schedule and assigns tasks and resolves informal grievances ; inspects work and performs inmate evaluations; reduces inmate idleness and… more
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