- City of New York (New York, NY)
- …7,500 diverse professionals and knowledgeable experts. The Office of Constituent and Grievance Services (OCGS) is hiring Grievance Investigators who are ... of persons in custody's grievances and electronic complaints; the administration of the grievance process in each housing facility to which they are assigned, the… more
- CVS Health (Frankfort, KY)
- …units. Ensure timely, customer focused response to appeals, complaints and grievance . Identify trends and emerging issues and report and recommend solutions. ... -Research incoming electronic appeals, complaints and grievance to identify if appropriate for unit based upon...work items that do not meet appeals, complaints and grievance criteria. -Research Standard Plan Design or Certification of… more
- Point32Health (MA)
- …. **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst is responsible per State ... and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with… more
- Commonwealth Care Alliance (Boston, MA)
- …Processing of Grievances & Appeals: + Responsible for the progress of grievance and appeal intervention and resolution. + Assure verbal and written responses ... verbal and written correspondence. + Thoroughly document all member appeal and grievance related interactions and interventions into CCA database. Member Outreach: +… more
- Elevance Health (Walnut Creek, CA)
- **Title: Grievance /Appeals Analyst I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... an accommodation is granted as required by law._ The ** Grievance /Appeals Analyst I** is an entry level position in...I** is an entry level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes… more
- Texas Health Resources (Arlington, TX)
- Patient Safety/ Grievance Program Manager - TH Urgent Care (Breeze), Full-time, Days _Bring your passion to Texas Health so we are Better + Together_ Work location: ... Patient Safety Risk Department: Looking to fill a dedicated Patient Safety-Risk/ Grievance position that facilitates all patient safety and clinical risk management… more
- Cognizant (Boston, MA)
- **Appeals & Grievance Specialist (remote)** This is a remote position open to any qualified applicant in the United States. **Job Summary:** We are seeking a ... dedicated Appeals & Grievance Specialist with 2 to 3 years of experience...due process was followed. Determine if the appeal or Grievance is legitimate. A strong understanding of Claims, Appeals… more
- Centene Corporation (Sacramento, CA)
- …Maintain files on individual appeals and grievances + May coordinate the Grievance and Appeals Committee + Support the pay-for-performance programs, including data ... High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals, claims, related managed care experience, or relevant experience.… more
- Transdev (New Carrollton, MD)
- Grievance / Quality Assurance (QA) Analyst Transdev is looking for a Grievance / Quality Assurance (QA) Analyst to join our team in New Carrollton, MD. We are ... seeking friendly, customer service-oriented individuals who are dedicated to safety and committed to providing the highest level of service. Transdev is proud to offer: + Competitive compensation package of minimum $23.00 - maximum $28.50 Benefits include: +… more
- Healthfirst (FL)
- …+ Independently manage a caseload of grievances through the full case lifecycle, from written acknowledgement to investigation, resolution, and written member ... resolution letters. + Conduct detailed research by collaborating cross-functionally with internal departments (eg, Member Services, Provider Operations, Clinical, Enrollment, Pharmacy) to identify root causes and recommend appropriate resolutions. + Partner… more
- AmeriHealth Caritas (Newark, DE)
- …+ Research and Investigate member and/or provider appeals and grievance requests, including review of UM/claim denial reasons, contract/regulatory rules, ... benefits, and documentation received on appeal/ grievance + Distribute meeting materials, reports, and follow-up documentation as needed. **;** + Facilitate, Manage,… more
- Transdev (North Las Vegas, NV)
- …ensure consistency in language and interpretation of collective bargaining agreements, grievance management, and arbitration preparation. Transdev is proud to offer: ... + Research, compile, and prepare data for use in grievance hearings, arbitration proceedings, labor/management initiatives, collective bargaining negotiations, and… more
- LA Care Health Plan (Los Angeles, CA)
- …manner. Coordinates, tracks, and resolves internal and external appeal and grievance complaints for LA Care Plan Partners, including identifying opportunities for ... improvement. Ensures timely appeal and grievance reporting to regulatory agencies, internal Regulatory Affairs and...Management) to ensure the use of appropriate appeal and grievance issue codes, timely resolution, and refers to community… more
- LA Care Health Plan (Los Angeles, CA)
- …manner. Coordinates, tracks, and resolves internal and external appeal and grievance complaints for LA Care Plan Partners, including identifying opportunities for ... Unit and other general operations units. Ensures timely appeal and grievance reporting to regulatory agencies, internal Regulatory Affairs and Compliance Department,… more
- Ventura County (Ventura, CA)
- …corrective actions while adhering to labor laws and regulations, and the grievance process, ensuring strict adherence to contract provisions and consistency in ... relations laws. + Advises departments and agencies on disciplinary actions, grievance procedures, recommends appropriate discipline levels, and prepares notices and… more
- Fallon Health (Worcester, MA)
- …and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance with CMS regulations, ... applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH Appeals and … more
- Texas Health Resources (Dallas, TX)
- …on RLts daily acting as the entity?s expert resource in complaint & grievance processes and keeps abreast of trends in the industry and regulatory standards. ... and laws. Develop and implement strategies to create and maintain a grievance process and event classification program. Oversee management of classification, event… more
- LA Care Health Plan (Los Angeles, CA)
- …Grievances Coordinator I supports the Customer Solution Center Appeals & Grievance Specialists by handling the administrative functions of the care ... staff to render decisions, assists the Customer Solution Center Appeals & Grievance Manager and Director in meeting regulatory timelines by maintaining an accurate… more
- MTA (New York, NY)
- …of Labor Relations, including maintaining contract interpretation and disciplinary grievance case data, preparing hearing calendars, notifying employees and/or ... in connection with the processing of Employee and Labor Relations discipline and grievance cases, schedules and coordinates grievance hearings. + Creates charts,… more
- Southern Company (Birmingham, AL)
- …by supporting the implementation and interpretation of labor agreements, managing grievance procedures, and ensuring compliance with federal and state labor laws. ... documents. + Advise supervisors and managers on contract interpretation, grievance handling, employee discipline, and other labor-related matters. + Participate… more
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