- Cognizant (Lansing, MI)
- ** Member Appeals & Grievances Specialist ** (remote) This is a remote position open to any qualified applicant that lives in the United States. ... **Summary:** We are seeking a dedicated Member Appeals & Grievance Specialist ...directly with CMS Billing and Coding-Medical Insurance Knowledge of Member /Provider Appeals and Grievances , processes,… more
- Molina Healthcare (Tampa, FL)
- Molina Healthcare is hiring for a Medicare Appeals & Grievances Specialist . This position is remote and will be working Pacific Standard hours. Highly ... **Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers,… more
- 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 (IA)
- Molina Healthcare is hiring for an Appeals & Grievance Specialist . This role is 100% remote and will work in the Pacific Time Zone. This role provides support ... **Essential Job Duties** + Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers,… more
- Molina Healthcare (IA)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance… more
- Molina Healthcare (Austin, TX)
- …and prepare responses to appeals and grievances . + Elevates appropriate appeals to the Appeals Specialist . + Generates and mails denial letters. ... **JOB DESCRIPTION** **Job Summary** Responsible for reviewing and resolving member & provider complaints and communicating resolution to members (or authorized)… more
- Baylor Scott & White Health (Temple, TX)
- … and Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and grievance cases for products for ... and resolution of cases; review, research and coordination of complaints, grievances , appeals and reconsiderations consistent with statutory and federal… more
- Molina Healthcare (OH)
- … Member issues in areas involving member impact and engagement including: Appeals and Grievances , Member Problem Research and Resolution, and the ... available to them, including preventive services. * Participates in annual member complaints and appeals training with health plan, including the member … 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
- 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
- LA Care Health Plan (Los Angeles, CA)
- … Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... to achieve that purpose. Job Summary The Customer Solution Center Training Specialist II is responsible for conducting functional training Customer Solution Center… more
- TEKsystems (Honolulu, HI)
- …critical analysis of highly complex and sensitive member and provider appeals , inquiries and grievances and applies internal policies and procedures, ... any new regulation, standard, business change, etc. affecting the member advocacy and/or appeals process. At direction of management, assists in the coordination… more
- Insight Global (San Francisco, CA)
- …to change - thrives in a fast-moving, start-up environment Experience with grievances , appeals , or quality assurance within healthcare operations Background in ... Job Description Insight Global is seeking a Remote Operations Support Specialist to join our growing Food Operations team. This role supports the day-to-day… 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
- LA Care Health Plan (Los Angeles, CA)
- …due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist .; submit all Grievances and Appeals response letters ... in the technical aspects of the retrospective review process for authorizations and Member or Provider Appeals , including, but not limited to computer data… more
- State of Colorado (Limon, CO)
- …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)
- …Plan or PERA Defined; + Contribution Plan plus 401K and 457 plans. Member Contribution Rates . Correctional Officers I-IV qualify as "Safety Officers" and are ... MINIMUM QUALIFICATIONS Six (6) years of relevant experience in grievances , investigations or legal standards and processes. -OR- A...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 ... and security protocol. + Resolve informal staff and/or inmate grievances and initiating corrective/disciplinary action if needed + Ensure...higher; CSTS II, CSLTS II, CO III or Safety Specialist III + At least one year maintaining facility… more
- State of Colorado (Denver, 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 ... pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness, and...and water treatment plant; position also assists the HVAC specialist with the repair and maintenance of all climate… more