• Appeals and Grievance Analyst

    Point32Health (Canton, MA)
    …here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
    Point32Health (02/29/24)
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  • Supervisor , Customer Solution Center…

    LA Care Health Plan (Los Angeles, CA)
    Supervisor , Customer Solution Center Appeals and Grievances (A Limited Duration) Job Category: Customer Service Department: CSC Appeals & Grievance ... exemption requests prior to proceeding with the recruitment process. Job Summary The Supervisor , Customer Solution Center Appeals & Grievances is responsible for… more
    LA Care Health Plan (01/02/24)
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  • Supervisor , Customer Solution Center…

    LA Care Health Plan (Los Angeles, CA)
    Supervisor , Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... to support the safety net required to achieve that purpose. Job Summary The Supervisor , Customer Solution Center Appeals & Grievances is responsible for direct… more
    LA Care Health Plan (12/30/23)
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  • Customer Solution Center Appeals

    LA Care Health Plan (Los Angeles, CA)
    Customer Solution Center Appeals and Grievances Specialist II (Temporary- 2 Month Term) Job Category: Customer Service Department: CSC Appeals & Grievances ... proceeding with the recruitment process. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
    LA Care Health Plan (02/09/24)
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  • Appeals and Grievances Administrator

    AmeriHealth Caritas (Philadelphia, PA)
    ** Appeals and Grievances Administrator** Location: Philadelphia, PA Primary Job Function: Medicare ID**: 31552 Your career starts now. We are looking for the next ... job is to: Under the general supervision of the Supervisor of Grievances, CTM and Critical Incidents, this position...regarding the Part C, Part D and Medicare-Medicaid Plan grievance processes. In addition, the Administrator will serve as… more
    AmeriHealth Caritas (03/26/24)
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  • Senior Medicare Appeals Analyst

    Corewell Health (Grand Rapids, MI)
    …State and Federal decisions are properly implemented. Assist the Lead, Supervisor and/or Manager in coordinating activities and in the development/collection of ... as a mentor/trainer to other team members. The Senior Appeals Analyst makes decisions on moderately complex issues regarding...issues. Qualifications + 5 years of relevant experience with grievance & or appeal analyst or related experience +… more
    Corewell Health (03/26/24)
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  • Supervisor , Authorization Technician

    LA Care Health Plan (Los Angeles, CA)
    Supervisor , Authorization Technician Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... the safety net required to achieve that purpose. Job Summary The Supervisor , Authorization Technician supports the Utilization Management (UM) Specialist by handling… more
    LA Care Health Plan (03/16/24)
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  • Benefits Claims Supervisor

    Trustmark (Washington, DC)
    …a variety of tasks including, but not limited to, Customer emails, Correspondences, Grievance and Appeals , HRA, Balance Bills and Transplants, enabling the team ... to bring the best to our colleagues, clients and communities. The Claims Supervisor is responsible for the day-to-day management of the Senior Analyst claims team,… more
    Trustmark (03/21/24)
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  • Pharmacy Benefit Specialist II

    CareOregon (Portland, OR)
    appeals and notify members and providers of outcome. + Assist the Appeals & Grievance Coordinators, Pharmacists, Medical Directors and Quality Improvement ... Job Code A133 Department Pharmacy Manager Title Pharmacy Benefit Operations Supervisor Direct Reports n/a Exemption Status Non-Exempt Management Level n/a… more
    CareOregon (03/21/24)
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  • Member Service Representative

    CDS Life Transitions (Webster, NY)
    …notices as requested, ensuring timeframes are met. + Documents information regarding grievance and appeals when the receiving party utilizing designated ... specifically in at least one of the following areas: call center operations, MLTC, grievance and appeals , and/or authorizations. + Ability to manage a high level… more
    CDS Life Transitions (02/29/24)
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  • Senior Labor Relations Representative

    MTA (New York, NY)
    …and participate in monthly conferences with union representatives to discuss contract grievance and employee discipline appeals ; perform analytical review of ... $100,000 HAY POINTS : 551 DEPT/DIV : Labor Relations SUPERVISOR : Assistant Director, Labor Relations LOCATION : 420...sanctioned by the National Mediation Board for all contract grievance and employee discipline cases. + Provide leadership and… more
    MTA (03/25/24)
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  • Correctional Youth Security Officer II - Betty K.…

    Colorado Department of Human Services (Denver, CO)
    …youth, in accordance with the living unit master schedule, shift supervisor and/or other administrative direction. Provide corrective cognitive, emotional or ... team meetings in collaboration with CYSO III + Ensure that youth grievance policy and procedure are followed. Review of grievances to include investigation,… more
    Colorado Department of Human Services (03/13/24)
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  • Correctional Youth Security Officer II - Summit…

    Colorado State (Golden, CO)
    …team meetings in collaboration with CYSO III + Ensure that youth grievance policy and procedure are followed. Review of grievances to include investigation, ... are applying. Incomplete employer information (address, phone number, and supervisor ) or omission of former employers may result in...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
    Colorado State (03/26/24)
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  • Correctional Youth Security Officer II - Platte…

    Colorado State (Greeley, CO)
    …team meetings in collaboration with CYSO III + Ensure that youth grievance policy and procedure are followed. Review of grievances to include investigation, ... are applying. Incomplete employer information (address, phone number, and supervisor ) or omission of former employers may result in...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
    Colorado State (03/25/24)
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  • HR Analyst - Policy and Employee/Labor Relations

    City of Lakeland (Lakeland, FL)
    …claims processing and represents the City of Lakeland in unemployment claims and appeals hearings, securing the participation of the HR Director and HR counsel for ... Skill in establishing and maintaining effective, professional working relationships with supervisor , co-workers, employees, and the general public. + Ability to… more
    City of Lakeland (03/15/24)
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  • Senior Human Services Program Specialist

    MyFlorida (Tampa, FL)
    …relation to funded services, DCF Trackers/inquiries, incident reporting, mortality reviews, grievance / appeals and utilizing this information to initiate regional ... Microsoft. Candidate Profile (application) must be completed in its entirety. + Include supervisor names and phone numbers for all periods of employment. + Account… more
    MyFlorida (03/13/24)
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