- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I...members. It will support the Appeals and Grievances team to receive, investigate and resolve member… more
- LA Care Health Plan (Los Angeles, CA)
- …Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider complaints and ... Customer Solution Center Appeals and Grievances Specialist ...experience in Managed Care with specific experience in resolving member and provider complaint and appeals issues,… more
- Molina Healthcare (San Antonio, TX)
- …CA Medi-Cal and Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or ... **Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers,… more
- Molina Healthcare (Chandler, AZ)
- …with research. * Determines appropriate language for letters and prepares responses to member appeals and grievances . * Elevates appropriate appeals ... problem-solving in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with… more
- Modivcare (Ridgeland, MS)
- …this opportunity may be the right fit for you! Modivcare is looking for an experienced Grievances & Appeals Specialist to join our team! This position is ... risk for service failure. This role + Handles high-risk member complaints and grievances . + Collects all necessary supporting information to accurately provide… more
- Tufts Medicine (Boston, MA)
- …research breakthroughs to life. **Job Overview** The Senior Employee & Labor Relations Specialist serves as a trusted subject matter expert and strategic partner to ... role may delegate and oversee the work of the Employee & Labor Relations Specialist . This position requires deep knowledge of both employment and labor laws (eg,… more
- ManpowerGroup (Alexandria, MN)
- …Contact Center Specialist ** to join their team. As a Transportation Contact Center Specialist , you will be part of the Member & Provider Services Department, ... matters to appropriate departments when necessary. + Identify issues related to grievances or appeals and follow proper procedures accordingly. **What's… more
- Molina Healthcare (Green Bay, WI)
- …to healthcare premium. * Assist in resolution for escalated premium issues with Appeals and Grievances team members. * Guide and collaborates with enrollment ... party with the amount due for the healthcare program the member is enrolled. * Guide and support Member Service representatives to help them resolve member … more
- Commonwealth Care Alliance (Boston, MA)
- …schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and ... are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental… more
- Molina Healthcare (NE)
- …quality and cost-effective member care. This position will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with ... Serves as a clinical resource for utilization management, CMOs, physicians and member /provider inquiries/ appeals . + Provides training and support to clinical… more
- State of Colorado (Chaffee County, CO)
- …Plan or PERA Defined. + Contribution Plan plus 401K and 457 plans. Member Contribution Rates . Correctional Officers I-IV qualify as "Safety Officers" and are ... hours and pay, creates schedule and assigns tasks and resolves informal grievances ; inspects work and performs inmate evaluations; reduces inmate idleness and… more
- State of Colorado (Chaffee County, CO)
- …Plan or PERA Defined. + Contribution Plan plus 401K and 457 plans. Member Contribution Rates . Correctional Officers I-IV qualify as "Safety Officers" and are ... employee evaluations and plans; conducts performance evaluations, resolves informal grievances ; creates schedules, assigns tasks, inspects work; approves time,… more