- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- Molina Healthcare (San Antonio, TX)
- …claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, ... and Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or authorized… more
- Molina Healthcare (Bowling Green, KY)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance … more
- Tufts Medicine (Boston, MA)
- …involving a variety of areas including employee discipline/corrective action and employee appeals and the grievance process. 2. Develops and modifies Employee ... research breakthroughs to life. **Job Overview** The Senior Employee & Labor Relations Specialist serves as a trusted subject matter expert and strategic partner to… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …and Management Team + Legal Department: + Medical Directors + Member Appeals Grievance Programs (Commercial, Medicare Advantage, and InterPlan Program) + ... your true colors to blue. The Role:The Peer Review Specialist is responsible for monitoring the quality of the...Credentialing & Peer Review (CPR) Team, the Peer Review Specialist works closely with CPR's Director and Clinical Lead,… more
- Washington Metropolitan Area Transit Authority (New Carrollton, MD)
- …events. + Recommends administrative actions based on investigation outcomes, support grievance procedures, and accident appeals , including providing expert ... Transportation Investigation Specialist Job ID: 251064 Location: MD-Metro Bldg New...events. **Job Summary** The Transportation Investigations & Safety Improvement Specialist leads in-depth investigations of transit bus collisions and… more
- Cedars-Sinai (CA)
- …CSHS employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process, etc. + Remains updated ... **Job Description** The Managed Care Compliance Specialist is responsible for assisting with the implementation...ID** : 11981 **Working Title** : Managed Care Compliance Specialist - Managed Care **Department** : MNS Managed Care… more
- Washington Headquarters Services (Alexandria, VA)
- …and case law. May be called upon to testify as a technical expert in appeals . Assigned to resolve the most sensitive and controversial cases. Serves as a senior ... specialist within the LMER division, Employee Relations Branch. As...to 1.) Develops policies, processes and procedures regarding the grievance system. 2.) Develops and/or updates policies and programs… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …referrals generated to care management programs + Provides administrative support to the grievance and appeals process within the + Medical Services department ... Depending on the specific tasks assigned, the Medical Services Coordination Specialist provides administrative support for any of the programs of Utilization… more
- Johns Hopkins University (Baltimore, MD)
- …actions and make sound recommendations to management. + Manage the grievance process, including fact finding, reviewing evidence, serving as hearing officer, ... as an advisor to employees and management on employee appeal and grievance issues. + Work in partnership with department management regarding appropriate… more
- State of Colorado (CO)
- …referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance with DOC Administrative ... of the department's action. For more information about the appeals process, the official appeal form, and how to...position, please direct your inquiries to our Employee Relations Specialist , Kristen Lange , at doc_###@state.co.us or call ###… more