- 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, ... required to achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and… more
- Point32Health (Canton, MA)
- …. **Job Summary** Under the general direction of the VP, the Appeals and Grievances Director is responsible for management and oversight ... of the Enterprise Member Appeals and Grievances Department. The Director is...IRE and overseeing the relationship with consultants + Primary representative during departmental audits + Responsible for coordinating with… more
- Elevance Health (Woburn, MA)
- …you a check, or ask you for payment as part of consideration for employment. **Grievance/ Appeals Representative II** + Job Family: CLM > Claims Support + Type: ... 2024 + Reference: JR110934 **Location:** + Massachusetts, Woburn **Description** **Grievance/ Appeals Representative II** **Location:** Hybrid 500 Unicorn Park… more
- Centers Plan for Healthy Living (Margate, FL)
- …in related area of responsibility, (ie utilization management, quality management, grievances , and appeals ) Type of Experience Required: Strong analytical ... RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate,...PHYSICAL REQUIREMENTS : The physical requirements described here are representative of those that must be met by an… more
- Concentrix (Albuquerque, NM)
- …their insurance related needs. Examples include: Inquiries regarding benefits, eligibility, appeals , grievances and troubleshooting medical devices. All while ... Job Title: Customer Service Representative -Remote (Healthcare) Job Description The Customer Service Representative -Remote, works from home and interfaces with… more
- Concentrix (Albuquerque, NM)
- …their insurance related needs. Examples include: Inquiries regarding benefits, eligibility, appeals , grievances and troubleshooting medical devices. All while ... Job Title: Customer Service Representative (Healthcare) Remote Job Description As a Customer... (Healthcare) Remote Job Description As a Customer Service Representative (Remote) you represent one our leading healthcare clients… more
- Kepro (Cheyenne, WY)
- …claim resolutions and other expressions of dissatisfaction. + Refer unresolved customer grievances , appeals , and claim resolution to designated departments for ... in the public sector. Acentra seeks a Customer Service Representative 1 to join our growing team. Job Summary:...join our growing team. Job Summary: This Customer Service Representative is a front-line service position aiding Wyoming Benefits… more
- Commonwealth Care Alliance (Boston, MA)
- …lines or medical setting preferred + Prior experience with service authorizations, grievances and appeals , scheduling medical appointments preferred + Ability to ... members and all those involved in CCA members' care. The Member Service Representative (MSR) is responsible to provide a best-in-class service experience to all… more
- MTA (New York, NY)
- …with union representatives to discuss contract grievance and employee discipline appeals ; perform analytical review of claims, grievances , and discipline ... Senior Labor Relations Representative Job ID: 6749 Business Unit: MTA Headquarters...24, 2024 Description JOB TITLE : Senior Labor Relations Representative SALARY RANGE : $90,000 - $100,000 HAY POINTS… more
- CVS Health (Hartford, CT)
- …claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals . + Initiates out-reach/welcome calls to ensure constituents ... Training Hours: + Training 9:00am-5:30pm + Shift: 8am-6pm Customer Service Representative + Answers questions and resolves issues as a "single-point-of-contact"… more
- CVS Health (Hartford, CT)
- …claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals . * Initiates out-reach/welcome calls to ensure constituents ... expectations are met or exceeded. Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase… more
- CVS Health (High Point, NC)
- …claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals .* Initiates out-reach/welcome calls to ensure constituents ... expectations are met or exceeded. Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase… more
- CVS Health (Sacramento, CA)
- …claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals . + Initiates out-reach/welcome calls to ensure constituents ... expectations are met or exceeded. + Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase… more
- CVS Health (Irving, TX)
- …claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals . + Initiates out-reach/welcome calls to ensure constituents ... expectations are met or exceeded. + Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase… 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
- Universal Health Services (Riverside, CA)
- …Data Collection, conduct relevant QI studies, and coordinate CPPI. Review/respond to grievances and appeals , monthly medication inventory audit, and monitor any ... CPPI (California Physician Performance Initiative). 9. Review/respond to health plan or individual grievances and appeals in a timely manner. 10. Assist with… more
- State of Colorado (Denver, CO)
- …development training (as available) + Resolves informal staff grievances . Provide formal/informal performance feedback. Initiate progressive discipline, in ... for all youth + Responds to and resolves youth grievances + Act as first public contact with agency...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
- State of Colorado (Denver, CO)
- …designation activities on behalf of the BHA and receives and investigates grievances submitted to the BHA through complaints and critical incident reporting. About ... the official appeal form, signed by you or your representative . This form must be delivered to the State...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Western Washington University (Bellingham, WA)
- …disciplinary actions + Provides support throughout adjudication processes, including grievances , unfair labor practices, complaints, appeals ; prepares detailed ... + Facilitate on-going communication and working relationships with employee representative organizations and other college stakeholders. + Supports the Director… more
- Centers Plan for Healthy Living (Brooklyn, NY)
- …+ Follow both nursing home and CPHL reporting procedures for incidents, appeals , grievances EDUCATION AND EXPERIENCE: Education Required: Master's level degree ... Scope of responsibilities include building connections with members, designated representative and the interdisciplinary care team (ICT) through assessing needs,… more