- 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, ... Job Summary The Manager , Customer Solution Center Appeals and Grievances is responsible for the...procedures. This position ensures the proper handling of member complaints whether presented by members, their authorized representative, the… more
- Apex Health Solutions (Houston, TX)
- Job Title: Appeals & Grievances Coordinator Department: Appeals and Grievances Supervisor: Manager , Appeals & Grievances FLSA Status: ... Nonexempt Summary The Appeals and Grievances coordinator position is focused on the processing of...and provider Medicare and Commercial appeals and grievances . This associate may screen incoming complaints ,… 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 ... Learn more at: https://prominence-health.com/ Job Summary: Under the direction of the Manager of Operations, the Appeals Specialist is responsible for ensuring… more
- Randstad US (Rancho Cucamonga, CA)
- …years of healthcare customer service experience, specifically handling grievances , appeals , and escalations. The Case Manager will communicate heavily with ... as quickly as possible. + Research, resolve and communicate complaints and grievances filed by members and...Problem Solving + Written Communication + Microsoft Office + Grievances and Appeals + Escalations + Conflict… more
- Highmark Health (Charleston, WV)
- …post critical incidents, for Quality of Care (QOC) and Quality of Service (QOS) concerns, appeals & grievances , and complaints . + Assist with questions and ... and continuity of care issues, support members throughout any grievances or appeals activities, assist members in...+ Work with members, providers and the member's case manager /care coordinator as needed to assist the member in… more
- Pacific Medical Centers (Seattle, WA)
- …for all post service, network and benefit appeals . Acts as second level manager for grievances . Works with patients and or vendor to reach resolution. Refers ... customer feedback on performance of assigned departments; resolves customer complaints , refers unresolved complaints onto the Executive...network and benefit appeals . Acts as second-level manager for grievances . Works with patients or… more
- Universal Health Services (Reno, NV)
- …enrollment and remediation of enrollment escalations such as CTM Complaints , Appeals and Grievances . The manager partners with various internal/external ... the patient experience. Learn more at: https://prominence-health.com/ Job Summary: The Manager of Medicare Enrollment is responsible for managing the day-to-day… more
- Veterans Benefits Administration (Winston Salem, NC)
- …supervisors and union representatives/officials to discuss and resolve employee performance issues, complaints or grievances . Work Schedule: 8:00 am - 4:30 pm ... Summary The Supervisory Veterans Service Representative (BEST Assistant Division Manager ) shares in the responsibility of managing BEST division operations through a… more
- Gwinnett County Public Schools (Suwanee, GA)
- …of Employee Relations will assist in providing resolution in matters related to grievances and appeals , training and development to administrators and employees ... ability to investigate effectively and document EEO-related violations and complaints , prepare recommendations to resolve problems, and work with...on equity, compliance, accommodation, grievances , and Title IX.1. Leads equal opportunity and other… more
- Veterans Affairs, Veterans Health Administration (North Chicago, IL)
- …knowledge of Federal personnel administration areas and processes such as appeals and grievances , management-employee relations, and recruitment and selection ... is not a virtual position. Position Description/PD#: Equal Employment Manager /PD183070 Financial Disclosure Report: Not required Requirements Conditions of… more
- Henry Ford Health System (Troy, MI)
- …for this opportunity. GENERAL SUMMARY: Responsible for addressing customer inquiries, grievances ( complaints ), identify appeals , process Individual plan ... Relationship Manager /Appeal and Grievance preferred. + A working knowledge of appeals , grievances , inquiries and the specific processes of how they should… more
- Actalent (Racine, WI)
- …to assist in establishing and maintain community links. Assists members with filing complaints , grievances or appeals and obtaining advocacy services as ... assigned caseload of program members in collaboration with an RN Care Manager + Completes comprehensive member assessments, member centered care plans, & functional… more
- Actalent (Mount Pleasant, WI)
- …to assist in establishing and maintain community links. Assists members with filing complaints , grievances or appeals and obtaining advocacy services as ... assigned caseload of program members in collaboration with an RN Care Manager * Completes comprehensive member assessments, member centered care plans, & functional… more
- State of Colorado (Denver, CO)
- …daily monitoring, performance management (planning, reviewing and evaluating), resolving complaints / grievances at the informal level, responsibility for ... and synthesizes information pertaining to conflict resolution; + Resolves offender grievances whenever possible; + Acts as a consultant and provides training… 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
- Naval Sea Systems Command (Pascagoula, MS)
- …and employee grievances . You will assist attorneys responding to EEO complaints , MSPB appeals , arbitrations, and unfair labor practice (ULP) charges and ... initial and annual ethics training. You will service as the Office Manager for the Office of the Counsel. Requirements Conditions of Employment Qualifications… more
- CVS Health (New Albany, OH)
- …center, including but not limited to customer service, claim, provider services, complaints , grievances , and appeals , implementation, and/or plan sponsor ... make health care more personal, convenient and affordable. Position Summary The Sr. Manager , Service Operations is a leader of leaders. This role will maintain… more
- Healthfirst (New York, NY)
- …departments + Clearly communicate resolutions and progress to the Providers + Assist Appeals and Grievances (A&G) department by acting as liaison between ... Under the direction of the Manager of Ancillary Services, the Ancillary Services Contractor...department to achieve favorable outcomes of member related issues, complaints , balance billing and other issues + Ensure that… more
- Commonwealth Care Alliance (Boston, MA)
- …or more core operational functions, including call centers, enrollment functions, and appeals / grievances . Knowledge, Skills & Abilities Required: + Knowledge of ... Service, Director of Provider Service, Senior Director of Member Communications, Manager of Training and Quality, Director of Business Strategy and Technology,… more
- Transdev (Hyattsville, MD)
- …policy. + May be called upon to testify on behalf of the company at union grievances or safety appeals meetings. + Ensures all required reports are submitted in ... review site conditions for safety hazards. + Investigate customer complaints related to operator performance and safety. + Conducts...as necessary or requested by the assistant or contract manager . + Maintains an orderly work area. The work… more