- Optum (San Juan, PR)
- …teams in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances . This position will communicate with appropriate ... implications and decisions. In addition, analyze and identifies trends for all appeals and grievances . Primary Responsibilities: Manage and resolve healthcare … more
- Sabio Systems, LLC (Reno, NV)
- …skills lab and clinical facilities prior to initiating clinical rotations. Manages student appeals and grievances per policy. Participates in the planning and ... clinical objectives. Meets with specific clinical faculty or agency educational representative to discuss and confirm number of students, faculty assignments, dates,… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, ... required to achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and… more
- Independent Health (Buffalo, NY)
- …responsible for the collection and review of medical records specific to quality complaints/ grievances and appeals as indicated in support of a high performing ... plan and physician network. The Clinical Reviewer will investigate quality complaints/ grievances and appeals , document research of initial coverage… more
- Fallon Health (Worcester, MA)
- …NCQA standards, other applicable regulatory requirements and member expectations. The FH Member Appeals & Grievances Coordinator serves to administer the FH ... of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Coordinator serves as a liaison between FH… more
- CVS Health (Carson City, NV)
- …claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals . + Initiates out-reach/welcome calls to ensure constituents ... heart, each and every day. **Position Summary:** Health Concierge -Customer Service Representative is the face of Aetna to provide targeted, personalized service… more
- Independent Health (Buffalo, NY)
- …of appeals /complaints. + Ensure verbal and written responses to complaints/ grievances , appeals and investigations follow regulatory standards. + Provide ... priority. + Monitor daily reports to ensure accuracy and timeliness of complaints/ grievances and appeals . + Assist in continuously developing systems, workflows,… more
- State of Colorado (Denver, CO)
- …employment laws; progressive discipline; records management; recruitment; responding to grievances , appeals , charges of discrimination; reorganization issues; ... state personnel rules, state and federal employment laws; responding to grievances , equal Employment Opportunity Commission (EEOC) claims, appeals , charges… more
- State of Colorado (Sterling, CO)
- …plans, and conducts performance evaluations; resolves informal staff and/or inmate grievances . Assigns tasks, monitors and inspects work progress and ensures ... pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness and...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
- State of Colorado (Colorado Springs, CO)
- …Individualized Program Instruction/Tutoring, Multi-Disciplinary Staffing, Responding to Offender Grievances and Resolving Offender Issues, Offender Housing Placement ... hearings, ICC, Multi disciplinary staffing, vetting responses to offender grievances etc. Therefore, experience as an entry level officer...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
- State of Colorado (Brighton, CO)
- …professional development training (as available). Resolves informal staff grievances . Provide formal/informal performance feedback. Initiate progressive discipline, ... interventions for all youth. Responds to and resolves youth grievances . Act as first public contact with agency when...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
- City and County of San Francisco (San Francisco, CA)
- …Duties: According to Civil Service Commission Rule 109, the duties specified below are representative of the range of duties assigned to this job code/class and are ... boards and commissions and in meetings with other departments. 7. Responds to appeals or protests of human resources decisions and/or procedures; and prepares and… more
- Transdev (Readville, MA)
- …of internal policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances . + Understand legal requirements and ... + Manage the grievance process and provide comprehensive responses to complaints, grievances , and arbitrations that support the Company's decision and comply with… more
- State of Colorado (Denver, CO)
- …conflicts, investigates and problem solves internal and external complaints and grievances from staff, youth, family, and other customers. Scheduling of clinic ... 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
- State of Colorado (Greeley, CO)
- …+ Ensure that youth grievance policy and procedure are followed. Review of grievances to include investigation, follow up and appropriate action Shift Supervision + ... 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
- State of Colorado (Limon, CO)
- …and ensuring the completion of annual training. + Resolve conflict and informal grievances at the lowest level possible + Ensure safe, efficient, compliant and cost ... 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
- State of Colorado (Pueblo, CO)
- …include dental holds, special diets and work restrictions; + Respond to offender grievances ; + Participate in the daily dental clinic operations to include tool ... 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
- State of Colorado (Rifle, CO)
- …hours and payroll, performs inmate performance evaluations, resolves informal grievances and makes recommendations for corrective or disciplinary actions. This ... 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
- University of Rochester (Albany, NY)
- …of claims. Collaborate with appropriate departments to generate a detailed rational for appeals and grievances to the insurance companies. + 10% Keeps management ... internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The Claims Resolution Representative III is responsible for working across the professional… more
- State of Colorado (Denver, CO)
- …Resolve employee performance problems and issues, disputes, and informal (Step 1) grievances ; issue corrective actions and initiate discipline as needed. Write and ... submitted by you, using the official appeal form signed by you or your representative . This form must be completed and delivered to the State Personnel Board by… more
