- Humana (Atlanta, GA)
- …a comprehensive analytic review of clinical documentation to determine if an a grievance , appeal or further request is warranted and then delivers final ... **Become a part of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting… more
- Fallon Health (Worcester, MA)
- …for member grievances and appeals, which includes, educating the member and/or member representative about the grievance / appeal , gathering all pertinent and ... relevant information from the member regarding the grievance / appeal , notifying the appropriate parties of the resolution and ensuring that all internal processes… more
- Willamette Dental (Hillsboro, OR)
- …understand how to facilitate the process with the Practice or Member Services Grievance , Appeal and Care Coordination. + Supports various outreach programs ... **Position Summary** The Member Services Representative communicates with members via incoming calls to efficiently and effectively answer membership questions… more
- LA Care Health Plan (Los Angeles, CA)
- …timely and culturally-appropriate manner. Coordinates, tracks, and resolves internal and external appeal and grievance complaints for LA Care Plan Partners, ... including identifying opportunities for improvement. Ensures timely appeal and grievance reporting to regulatory agencies, internal Regulatory Affairs and… more
- State of Colorado (Greeley, CO)
- …Personnel Director. An appeal or review must be submitted on the official appeal form, signed by you or your representative . This form must be delivered ... team meetings in collaboration with CYSO III + Ensure that youth grievance policy and procedure are followed. Review of grievances to include investigation,… more
- State of Colorado (Pueblo, CO)
- …and assistance in ensuring individual rights are protected, implementation of grievance processes, transition planning, and obtaining benefits as needed. + Assists ... other duties as assigned. Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights Mon-Fri 8-5 PM (work from home 3 days/office 2 days)… more
- State of Colorado (CO)
- …Personnel Director. An appeal or review must be submitted on the official appeal form, signed by you or your representative . This form must be delivered ... referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance with DOC Administrative… more
- State of Colorado (Denver, CO)
- …be timely on the basis of written material submitted by you, using the official appeal form signed by you or your representative . This form must be completed ... staff grievances and participate in any higher level disciplinary or grievance meetings. Minimum Qualifications, Substitutions, Conditions of Employment & Appeal… more
- Commonwealth Care Alliance (Boston, MA)
- …any requested documents including provider listings in their areas. * Complete comprehensive appeal and grievance intakes. * Collaborate with the member to ... accurately document their appeal or grievance concern by ensuring all...of concerns or complaints conveyed by members and their representative . * Conduct research to provide accurate and informed… more
- CUNY (New York, NY)
- …immigration. The Special Counsel serves as hearing officer of disciplinary and grievance proceedings and represents the College at higher levels of the disciplinary ... and grievance processes. The Special Counsel also serves as the...as student disciplinary appeals; advocates the College's position at appeal hearings. - Works with attorneys in CUNY's Office… more
- Commonwealth Care Alliance (Boston, MA)
- …are resolved timely to meet regulatory timeframes. + Documents and logs appeal / grievance information on relevant tracking systems. + Utilize industry guidelines, ... review. + Prepares recommendations to either uphold or deny appeal and forwards to Medical Director as needed. +...English **Other:** + The physical demands described here are representative of those that must be met by an… more
- Kelly Services (Greece, NY)
- …ensure customer satisfaction and retention. + Utilizing your understanding of the Grievance & Appeal process and other relevant terms. **Essential ... by management. **What's a typical day as a Medicare Customer Service Representative ? You'll be:** + Responding to member inquiries through phone, fax, email,… more
- Ramsey County (Maplewood, MN)
- …or without cause. Employees in the unclassified service have no right to a grievance appeal from discharge or other disciplinary action under sections 383A.281 ... measures for departmental activities + Serve as a department representative during contract negotiations with collective bargaining agreements; research issues… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …defined process for handling Medicare Grievances, identify differences between an inquiry, grievance , & appeal , and meet specific schedule requirements (may have ... **Additional Accountabilities and Essential Functions** _The Physical Demands described here are representative of those that must be met by an employee to… more