- CVS Health (Baton Rouge, LA)
- …from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance . Responsible for day-to-day implementation of ... case load including but not limited to: -Research incoming electronic appeals , complaints and grievance to identify if appropriate for unit based upon published… more
- Humana (Atlanta, GA)
- …Previous inbound call center or related customer service experience + Prior grievance and appeals experience + Previous experience processing medical ... and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by...review of clinical documentation to determine if an a grievance , appeal or further request is warranted and then… more
- Conduent (East Hartford, CT)
- …be part of a culture where individuality is noticed and valued every day. ** Appeals Coordinator - Customer Experience Associate IV** **Summary:** As an ** ... Coordinator - Customer Experience** analyze and resolve verbal and written appeals from consumers. Respond to requests for information from Department Hearing… 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 Angeles, CA, US, ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- Healthfirst (NY)
- …Responsibilities:** + Conduct quality audits of A&G items including grievances, pre-service appeals , and post service appeals utilizing appropriate sources of ... improve processes and performance to ensure quality. + Review and investigate appeals and grievances requests to ensure all requests are identified, classified, and… more
- LA Care Health Plan (Los Angeles, CA)
- …Duties Responsible for providing ongoing training on the core processing system, Appeals and Grievance (A&G) processing procedures, training regulatory changes ... Customer Solution Center Appeals and Grievances Training Development Specialist III Job...instructional design and training facilitation. Experience in Managed Care, Medicaid , Medicare experience. Experience working in an Agile or… more
- Humana (Phoenix, AZ)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... and other sources of expertise. Medical Directors will learn Medicaid requirements, and will understand how to operationalize this...member population, or condition type. May also engage in grievance and appeals reviews. May participate on… more
- Humana (Harrisburg, PA)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team… more
- Humana (Charleston, WV)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational… more
- Somatus (Mclean, VA)
- …+ Oversee new client pre-delegation audits, annual client audits, development of grievance and appeals workflow processes, and other regulatory requirements. + ... provides guidance and oversight to all lines of business including Commercial, Medicaid , Medicare, and Special Need Plans (SNPs). The Director, Quality will work… more
- Highmark Health (Harrisburg, PA)
- …This position is also responsible for assisting members in navigating the grievance and appeals process and representing member interests internally and ... **Required** + High School / GED **Substitutions** + None **Preferred** + Associate 's Degree **EXPERIENCE** **Required** + 1 year in Community Outreach or Customer… more
- BrightSpring Health Services (Louisville, KY)
- …to Member and Provider issues. Refer all unresolved issues to the next level including grievance and appeals . + Actively market plan to new senior care partners ... and marketing presentations in accordance with applicable Centers for Medicare & Medicaid Services (CMS) and State guidelines and standards. + Conduct individual… more