- Humana (Topeka, KS)
- **Become a part of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by ... trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced… more
- Fallon Health (Worcester, MA)
- …other applicable regulatory requirements and member and provider expectations. The FH Appeals and Grievances Triage Administrator serves to administer the FH ... standards. The Triage Administrator is responsible for triaging and assigning all incoming appeals and grievances addressed to the Member Appeals &… more
- AmeriHealth Caritas (Philadelphia, PA)
- …more about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances , this position is responsible for the ... complaints/issues to management + Monitors to ensure that all problems with appeals / grievances presented by plan members/participants are resolved in accordance… more
- 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
- Independent Health (Buffalo, NY)
- …responsible for the collection and review of medical records specific to quality complaints/ grievances and appeals as indicated in support of a high performing ... plan and physician network. The Clinical Reviewer will investigate quality complaints/ grievances and appeals , document research of initial coverage… more
- Fallon Health (Worcester, MA)
- …NCQA standards, other applicable regulatory requirements and member expectations. The FH Member Appeals & Grievances Coordinator serves to administer the FH ... of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Coordinator serves as a liaison between FH… more
- Concentrix (Baton Rouge, LA)
- …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 Title: Customer... (Healthcare) - Remote Job Description Title: Customer Service Representative (Remote) Location: United States JOB DESCRIPTION The Customer… more
- ManpowerGroup (Menomonee Falls, WI)
- …a liaison between providers and the **Member Services** team, handling **eligibility issues, appeals , and grievances .** + Guide providers on utilizing the **web ... **Job Title: Customer Service Representative - Dental & Vision** **Location: On-site -...medical insurance is a plus. As a **Customer Service Representative ** , you will: + Assist dental and vision… 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
- CVS Health (Atlanta, GA)
- …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
- State of Colorado (Denver, CO)
- …creating schedules and assigning tasks; + Resolving conflict and informal grievances at the lowest level possible; + If necessary, physically controlling ... daily monitoring, performance management (planning, reviewing and evaluating), resolving complaints/ grievances at the informal level, responsibility for scheduling and… more
- Roper St. Francis (Charleston, SC)
- …legal field, customer service or healthcare preferred. Prior experience working with grievances and appeals strongly preferred. Knowledge of RSFH organizational ... Summary** **:** The Patient Relations & Legal Coordinator aids in complaints and grievances management as well as legal matters to include coordinating with outside… more
- State of Colorado (Chaffee County, CO)
- …of overtime costs and staff fatigue. + Experience in reviewing employee grievances to include providing written responses and developing plans of action for ... to include after action reviews, responding to offender disciplinary appeals , answering offender classification appeals , review of...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
- State of Colorado (Golden, CO)
- …This supervision entails assigning and evaluating work, handling informal grievances , initiating corrective and disciplinary actions, and participating in the ... This supervision entails assigning and evaluating work, handling informal grievances , initiating corrective and disciplinary actions, and participating in the… more
- State of Colorado (Pueblo, CO)
- …and annual audits for education/special education. Responds to any appeals regarding education/special education, special education legal issues, due process ... services, which includes developing and monitoring performance, resolving informal grievances , corrective and disciplinary actions, and ensuring ongoing education… more
- State of Colorado (Sterling, CO)
- …inmate hours and pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness and creates real life ... 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 (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 (Pueblo, CO)
- …plans; signs performance plans and appraisals; and resolves informal/formal grievances + Initiates and/or delegates the hiring process, interviews applicants, ... 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 (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