- Molina Healthcare (Omaha, NE)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. +… 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 ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and ... as well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is… 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
- 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
- Robert Half Accountemps (Los Angeles, CA)
- …A Medical IPA Group in Los Angeles is in the immediate need of a Grievance & Appeals Specialist . The Grievance & Appeals Specialist , will be in ... with State/Federal laws, rules, and guidelines. The Grievance & Appeals Specialist will be expected to perform...Basic Medical Terminology * Proven track record in handling Appeals and Medical Grievances * Excellent coordination… 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...develop performance plans and sign performance documents; resolve informal grievances ; provide coaching, mentoring, approve leave, manage workloads; +… 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 Aurora, CO Job Type Full Time Job Number PAR 6412 CPSIII Aurora Department Department of… more
- Commonwealth of Pennsylvania (PA)
- …Maintains inmate files for compliance with applicable laws and regulations and tracks appeals , misconducts, and grievances in electronic databases and paper case ... Records Specialist 1 - SCI Fayette Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5017754) Apply Records Specialist 1 - SCI Fayette… more
- Navy Exchange Services (NEX) (Virginia Beach, VA)
- Title: Labor/Employee Relations Specialist I/ II/ III (Non-competitive Progression) Location: United States-Virginia-Virginia Beach Job Number: 250000Q1 Note: This ... Summary: Under the guidance and supervision of a Labor/Employee Relations Specialist or Labor/Employee Relations Manager, responsible for providing technical support… more
- Arab Community Center for Economic and Social Serv (Dearborn, MI)
- …to access services and rights processes + Assist with resolution of local complaints, grievances , and appeals processes + Survey, track, trend, and report on ... Intake & Customer Service Specialist Department: Community Health & Research Center Location: Dearborn, MI START YOUR APPLICATION… 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
- Defense Logistics Agency (New Cumberland, PA)
- …on serious/sensitive issues to Fed civilian employees, eg discipline, grievances , appeals , complaints, communications, employee/supervisory relationships, and ... Conditions of Employment Qualifications To qualify for a Human Resources Specialist (Employee Relations & Labor Relations), your resume and supporting documentation… more
- City of New York (New York, NY)
- …of Correction ("DOC" or "the Department"); - Investigate serious incidents; - Review grievances from people in custody and staff; - Evaluate the performance of DOC; ... a period of growth and change. JOB DESCRIPTION The Board seeks a Standards Specialist ("Monitor") with a passion for justice, fairness, and human rights, and the… more
- Centene Corporation (Jefferson City, MO)
- …division of financial responsibility interpretation, contract rate and language interpretation, appeals , grievances and eligibility. + Serve as primary point ... of contact and liaison between assigned providers and the health plan. + Provide issue resolution support for most complex provider contracts by researching and partnering to resolve provider claims and data issues. + Act as department subject matter expert. +… more
- Commonwealth Care Alliance (Boston, MA)
- …schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and ... resolve reimbursement concerns. + Conduct retrospective audits to identify systemic payment issues and recommend resolution pathways. + Interpret and apply MassHealth fee schedules, All-Payer Rate Setting regulations, and CMS payment methodologies (eg, DRG,… more
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