- LA Care Health Plan (Los Angeles, CA)
- …within the Appeals & Grievances Department to ensure clinical grievances , complaints , appeals and complex issues are investigated and resolved ... Manager, Appeals and Grievances General Operations (RN-Clinical)...experience with at least 3 years of experience with health care grievance and/or appeals issues, preferably… more
- LA Care Health Plan (Los Angeles, CA)
- …Provide direction to staff for complex/sensitive member and provider inquiries, concerns, complaints , appeals , and grievances . Conduct weekly 1:1s with ... Supervisor, Customer Solution Center Appeals and Grievances Job Category: Customer...in Managed Health , preferably in Customer Service, Appeals and Grievances and/or Claims. Skills Required:… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the...Experience Required: At least 5 years of experience resolving health care eligibility, access, grievance and appeals … more
- Apex Health Solutions (Houston, TX)
- …processing of customer and provider Medicare and Commercial appeals and grievances . This associate may screen incoming complaints , process medical necessity, ... TPA Staff as may be necessary to effectively resolve appeals , complaints and quality of care or...year of health insurance/managed care experience performing Appeals and Grievances functions. Will consider managed… 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, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will...II will receive, investigate and resolve member and provider complaints and appeals exercising strong independent judgment.… more
- LA Care Health Plan (Los Angeles, CA)
- …area within the department. Investigation, and resolution of clinical member complaints ( grievances / appeals ) utilizing all regulatory requirements. ... (Mid.) - $142,166.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created by...Investigation, and resolution of clinical Provider Complaints / Provider Data Resolution (PDR) ( grievances / appeals… more
- Molina Healthcare (Milwaukee, WI)
- …**KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina ... internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to...Min. 2 years operational managed care experience (call center, appeals or claims environment). + Health claims… more
- Randstad US (Columbus, OH)
- … from members. + Gather, analyze and report verbal and written member and provider complaints , grievances and appeals + Prepare response letters for member ... and provider complaints , grievances and appeals +...In addition, Randstad offers a comprehensive benefits package, including health , an incentive and recognition program, and 401K contribution… more
- CVS Health (Fresno, CA)
- …and quality measures, with respect to letter content and turn-around time for appeals , complaints and grievances handling. -Independently researches and ... Bring your heart to CVS Health . Every one of us at CVS ...case load including but not limited to:-Research incoming electronic appeals , complaints and grievance to identify if… more
- Universal Health Services (Reno, NV)
- …the appropriate review, research, processing and responding to written member and provider complaints , appeals , and grievances . This position is required to ... Responsibilities Prominence Health is headquartered in Reno, Nevada and is...company policies and procedures, and NCQA/HEDIS standards applicable to complaints and appeals process. + Knowledge of… more
- Centene Corporation (Phoenix, AZ)
- … from members. + Gather, analyze and report verbal and written member and provider complaints , grievances and appeals + Prepare response letters for member ... million members as a clinical professional on our Medical Management/ Health Services team. Centene is a diversified, national organization...and provider complaints , grievances and appeals +… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …+ Logs and tracks verbal or written member grievances and appeals . + Conducts relevant research into complaints and collaborates, coordinates and ... health service environment. Previous experience in Managed Care grievances / appeals preferred. Strong communication, organizational, critical thinking, and… more
- Centene Corporation (Phoenix, AZ)
- …case load. + Ensure that the Appeals & Grievance department processes all appeals , grievances and complaints in accordance with standards and the ... Bachelor's degree in a related field or equivalent experience. 2+ years of appeals and grievances processing experience in a healthcare or managed care… more
- Pacific Medical Centers (Seattle, WA)
- …appeals for presentation. Decision maker for all post service, network and benefit appeals . Acts as second level manager for grievances . Works with patients ... appeals for presentation. Decision maker for all post-services, network and benefit appeals . Acts as second-level manager for grievances . Works with patients… more
- Randstad US (Rancho Cucamonga, CA)
- …quickly as possible. + Research, resolve and communicate complaints and grievances filed by members and communicate Health Plan's decisions appropriately ... candidates has 6+ years of healthcare customer service experience, specifically handling grievances , appeals , and escalations. The Case Manager will communicate… more
- State of Colorado (Sterling, CO)
- …daily monitoring, performance management (planning, reviewing and evaluating), resolving complaints / grievances at the informal level, responsibility for ... daily monitoring, performance management (planning, reviewing and evaluating), resolving complaints / grievances at the informal level, responsibility for… more
- Veterans Affairs, Veterans Health Administration (IN)
- …plans and directs work, assigns tasks, evaluates work, advises employees, handles complaints , and grievances . Ensures adequate training of subordinates. Provides ... Handbooks and directives. Experience responding to inquiries, disciplinary actions, grievances and appeals . Experience representing management in arbitrations.… more
- Veterans Affairs, Veterans Health Administration (Chicago, IL)
- …knowledge of Federal personnel administration areas and processes such as appeals and grievances , management-employee relations, and recruitment and selection ... in support of EEO, Affirmative Action, and strategies for resolving EEO complaints . -Maintains a diversity management program and conducts analysis on the facility's… more
- Carnival Cruise Line (Miami, FL)
- … grievances raised. + Uses past knowledge and experience to review grievances , complaints , and concerns received via various communication channels including ... related issues, policy, and procedure. + Works autonomously using experience to review appeals from team members to return from a breach of contract (termination or… more
- State of Colorado (Denver, CO)
- …and designation activities on behalf of the BHA and receives and investigates grievances submitted to the BHA through complaints and critical incident reporting. ... Department of Human Services Division OBH (Office of Behavioral Health ) Opening Date 04/17/2024 Closing Date 4/29/2024 11:59 PM...of the department's action. For more information about the appeals process, the official appeal form, and how to… more