- Accounting Now (Tampa, FL)
- Medicare Appeals Specialist Do you like challenging...will be well versed in the Medicare managed care appeals and grievance process. Must have strong ... well-supported appeal arguments, where an appeal is warranted.Filing complaints and grievances through the CMS and Medicaid systems to resolve unfair payment… more
- Molina Healthcare (Milwaukee, WI)
- …+ 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
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management/ Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist...to computer learning. Time management and priority setting skills. Must be organized and a team player Able to… 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 ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist ...of Medical terminology and strong advocacy experience. Skills Required: Must be organized, detail oriented, able to exercise strong… more
- Generac Power Systems (Waukesha, WI)
- ** Appeals & Grievances Specialist ...stoop, bend or reach above the shoulders. The employee must occasionally lift up to 25 pounds. Specific conditions ... I** **Company** Generac Power Systems **Name** Appeals & Grievances Specialist I **Req #** 64663 **Employment Type** Full Time **Shift** 1st It's a… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Training Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: ... achieve that purpose. Job Summary The Customer Solutions Center Appeals and Grievances (A&G) Training Specialist...data, processes, operating and maintenance instructions and procedure manuals. Must be a strong team player willing to work… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Coordinator I Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, ... safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Coordinator I supports the Customer Solution Center … more
- Universal Health Services (Reno, NV)
- …Job Summary: Under the direction of the Manager of Operations, the Appeals Specialist is responsible for ensuring the appropriate review, research, ... processing and responding to written member and provider complaints, appeals , and grievances . This position is required to apply analytical and critical thinking… more
- Elevance Health (Woburn, MA)
- …you will make an impact:** + Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues. ... medical staff or outside consultant. + Triages clinical and non-clinical inquiries, grievances and appeals , prepares case files for member grievance… more
- CareOregon (Portland, OR)
- …customer service, claims processing, prior authorizations, formulary exceptions, appeals , grievances , and project participation. Essential Responsibilities ... Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona,...decisions. + Perform prior authorization reviews with pharmacist oversight. Appeals and Grievances + Explain pharmacy appeal… more
- Veterans Affairs, Veterans Health Administration (IN)
- …and Directives. Responding to inquiries and procedures for disciplinary actions, grievances , and appeals concerning timeliness, documentation, and other ... Summary This position serves as a Lead Human Resources Specialist with subject matter expertise in all matters of Employee/Labor Relations within VISN 16. NOTE: This… more
- Drug Enforcement Administration (Arlington County, VA)
- …on a variety of issues relating to disciplinary and adverse actions, performance, grievances , and appeals . Responsibilities As the federal agency whose mission ... variety of issues relating to disciplinary and adverse actions, performance, medical, grievances and appeals . Modifying existing training materials to keep pace… more
- Naval Air Systems Command (Jacksonville, FL)
- …civilian personnel policies and procedures in labor relations matters (eg, discipline, grievances , appeals , fair employment practices). You will collaborate with ... Summary You will serve as a HUMAN RESOURCES SPECIALIST (LABOR & EMPLOYEE RELATIONS) in the FLEET...party). Requirements Conditions of Employment Qualifications GS-11 Your resume must demonstrate at least one year of specialized experience… more
- State of Colorado (Denver, CO)
- Employee & Labor Relations Human Resources Specialist Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4475856) Apply Employee & Labor ... Relations Human Resources Specialist Salary $56,028.00 - $70,032.00 Annually Location Denver, CO Job Type Full Time Job Number FAA01048-04/18/24 Department… more
- Commonwealth of Pennsylvania (PA)
- …Maintains inmate files for compliance with applicable laws and regulations and tracks appeals , misconducts, and grievances in electronic databases and paper case ... Records Specialist 1 - SCI Waymart Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/4469538) Apply...combination of experience and training. Other Requirements: + You must be able to obtain and maintain an active… 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 ... you are found well qualified for this vacancy. To be well qualified, you must satisfy all qualification requirements for the vacant position and score 85 or better… more
- FLACRA (Clifton Springs, NY)
- …closely with all Managed Care insurance providers and their policies and procedures on grievances and appeals , and assists the client in pursuing advocacy as ... UTILIZATION MANAGEMENT SPECIALIST Finger Lakes Addiction Counseling and Referral Agency...and efficiency of the use of FLACRA Residential services. Must Have Qualifications: + Associates Degree in Business Administration… more
- Naval Air Systems Command (Patuxent River, MD)
- …You will utilize working knowledge of policies and practices including appeals and grievances , labor relations, position classification, recruitment and ... Summary This Equal Employment Opportunity Specialist position is located in the Human Capital...as assigned. Requirements Conditions of Employment Qualifications Your resume must demonstrate at least one year of specialized experience… more
- US Army Communications Electronics Command (Tobyhanna, PA)
- …Resolve simple, informal complaints of employees and refer others, such as formal grievances and appeals , to the supervisor or an appropriate management ... Military Spouse Preference (MSP) Eligible Reinstatement In order to qualify, you must meet the experience requirements described below. Experience refers to paid and… more
- State of Colorado (Denver, CO)
- …all committed youth at each youth center are assigned a Behavioral Health Specialist who provides individual therapy each week. They also attend at least three ... Plan, and other programmatic initiatives of the Division. Performance Management + Must display knowledge and skill in supervision of subordinate staff whose work… more
