- Molina Healthcare (Columbus, OH)
- …+ 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
- 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
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC ... Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting the Appeal and Grievances… 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
- 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 ... Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the… more
- Area Agency On Aging 1-b (Southfield, MI)
- … and Grievance Specialist is responsible for managing and resolving appeals and grievances in accordance with contractual, regulatory, and accreditation ... and in administrative hearing proceedings. Duties Include: + The Appeals and Grievance Specialist is responsible for... Specialist is responsible for managing and resolving appeals and grievances in accordance with contractual,… more
- Centers for Medicare & Medicaid Services (Woodlawn, MD)
- …Center for Medicare, Division of Appeals Operations (DAO), Medicare Enrollment & Appeals Group (MEAG). As a HEALTH INSURANCE SPECIALIST , GS-0107-14, you will ... the following areas: Medicare Parts A,B, C, & D claim appeals and grievances . Responsibilities Provide Medicare claims appeals operational guidance and… 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
- Space and Naval Warfare Systems Command (Loma, ND)
- …on the technical aspects of personnel administration during formal hearings, grievances and appeals . Requirements Conditions of Employment Qualifications NO-04: ... Summary You will serve as an Administrative Specialist in the Human Resources Office of NAVWARSYSCEN...and assistance in the areas of discipline, adverse actions, grievances , employee counseling, and related functions including appropriate options… more
- BayCare Health System (Clearwater, FL)
- …provide updates to management. + Identify trends or recurring issues in member grievances and appeals and recommend process improvements to prevent future ... respect, responsibility and clinical excellence. **Summary:** + Manages intricate grievances , collaborating closely with healthcare providers and members to resolve… more
- State of Colorado (Colorado Springs, CO)
- Youth Services Specialist II - Spring Creek Youth Services Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5096121) Apply Youth ... Services Specialist II - Spring Creek Youth Services Center Salary...youth grievance policy and procedure are followed. Review of grievances to include investigation, follow up and appropriate action… 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)
- …Conducts critical analysis of highly complex and sensitive member and provider appeals , inquiries and grievances and applies internal policies and procedures, ... new regulation, standard, business change, etc. affecting the member advocacy and/or appeals process. At direction of management, assists in the coordination of… more
- US Marine Corps (Aiea, HI)
- …You will resolve simple, informal complaints of employees and refer others (formal grievances and appeals ) to the supervisor or an appropriate management ... Summary You will serve as a in the LEAD LOGISTICS MANAGEMENT SPECIALIST in the STRATEGIC MOBILITY BRANCH of MARINE FORCES PACIFIC. This is a RE-ADVERTISEMENT of… 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
- Justice, Bureau of Prisons/Federal Prison System (Washington, DC)
- …Some examples of this qualifying experience are: GS-13: Experience investigating grievances submitted as administrative remedy appeals , regarding Women and ... Special Populations policies and procedures. Experience implementing and/or evaluating evidence-based programs for women or members of other special populations (aging offenders, parents or pregnant inmates, inmates living with disabilities, and/or veterans);… more
- TEKsystems (Honolulu, HI)
- This job is fully in-person in Honolulu, HI Job Description + Manage appeals and grievances across all lines of business, including Medicare and Quest. + Address ... member complaints such as: + Rude customer service interactions + Dissatisfaction with benefits + Conduct case research, draft formal letters to members, and coordinate with internal departments. Then, Medical Directors will make final decisions on cases. +… 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
- State of Colorado (Sterling, CO)
- …plans, and conducts performance evaluations; resolves informal staff and/or inmate grievances . Assigns tasks, monitors and inspects work progress and ensures ... pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness and...of the department's action. For more information about the appeals process, the official appeal form, and how to… 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