- BroadPath Healthcare Solutions (Tucson, AZ)
- **Overview** BroadPath is excited to announce that we are hiring **Work from Home Appeals and Grievance Specialists** . The Appeals and Grievance ... a key role in helping members navigate and understand their benefits related to Appeals , External Medical Review, and the Fair Hearing process. Acts as the first… more
- Harbor Health Services, Inc. (Mattapan, MA)
- …knowledge of all aspects of managed care medical management including UM/CM, Grievance and Appeals , inpatient and outpatient services, medical policy, and ... process improvement, communication to employees about QI efforts. Working with the Appeals and Grievances Specialist, maintains oversight of the Grievances and … more
- State Bar of Texas (Houston, TX)
- …Commission for Lawyer Discipline in attorney disciplinary proceedings before District Grievance Committees, District Courts, and the Board of Disciplinary Appeals ... in attorney discipline litigation, including hearings before evidentiary panels of the grievance committee, district court trials and proceedings before the Board of… more
- Elevance Health (Cerritos, CA)
- **Title: Grievance / Appeals Analyst I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... for employment, unless an accommodation is granted as required by law._ The ** Grievance / Appeals Analyst I** is an entry level position in the Enterprise … more
- Centene Corporation (Phoenix, AZ)
- …**Position Purpose:** Analyze and resolve verbal and written claims and authorization grievance / appeals from providers and members. Resolve all State inquires ... appeal decisions. + Act as subject matter expert regarding grievances and appeals . + Lead Appeals and Grievance Committee + Performs other duties as assigned… more
- Centene Corporation (Phoenix, AZ)
- …member and provider complaints, grievances and appeals + Maintain files on individual appeals and grievances + May coordinate the Grievance and Appeals ... High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals , claims, related managed care experience, or… more
- Elevance Health (Mason, OH)
- …by medical directors and consultants; preparing recommendations to uphold or deny appeals ; and ensuring all grievance processes are completed within regulatory ... legal proceedings, and/or paralegal experience is strongly desired. .Understanding of the grievance and appeals process is strongly preferred. .Basic knowledge… more
- Point32Health (FL)
- …Point32Health (https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
- CVS Health (Baton Rouge, LA)
- …from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance . Responsible for day-to-day implementation of ... case load including but not limited to: -Research incoming electronic appeals , complaints and grievance to identify if appropriate for unit based upon published… more
- Henry Ford Health System (Troy, MI)
- …for the prompt and thorough investigation of medical and pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): Commercial, Medicare Advantage, ... + Conduct the primary investigation and resolution of member appeals and grievances following established guidelines from: The Center...as part of their onboarding to the Appeal and Grievance Team. + Perform other related duties as assigned.… more
- CVS Health (Hartford, CT)
- …AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. * Health Plan Experience Highly ... of this Medical Director role are related to Medicare Appeals :** * Direct daily work on part C ...Appeals :** * Direct daily work on part C appeals (both provider and member/nonparticipating providers) * Provide direct… more
- LA Care Health Plan (Los Angeles, CA)
- …the Clinical Programs. + Develop and execute on strategic opportunities to improve the overall appeals & grievance process. Create a best in clinical appeals ... experience with at least 3 years of experience with health care grievance and/or appeals issues, preferably in a managed care or Medicaid Health Plan environment… more
- CareFirst (Baltimore, MD)
- …The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and determination of next steps for Government ... II and III with unit projects and other duties related to the appeals , grievance , and/or reconsideration process. Communicates with Supervisor to offer feedback… more
- Point32Health (Canton, MA)
- …(https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
- Sanford Health (Sioux Falls, SD)
- …strategic oversight and operational management of the organization's member and provider appeals , complaints, and grievance processes across all product lines, ... adherence to all state, federal, CMS, HHS, and quality regulations governing appeals and grievance resolution. Lead and manage the end-to-end appeals and… more
- Molina Healthcare (Tampa, FL)
- …claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, ... **Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances, and/or complaints from Molina members, providers, and… more
- LA Care Health Plan (Los Angeles, CA)
- …RN is responsible for assisting with the development of a successful and cohesive Appeals and Grievance (A&G) clinical unit. This position is responsible for the ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position… more
- CVS Health (Baton Rouge, LA)
- …of responses from multiple business 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 published business… more
- CVS Health (Baton Rouge, LA)
- …of responses from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance . Identify trends and emerging issues and ... Must reside in Louisiana Responsible for intake, investigation and resolution of appeals , complaints and grievances scenarios for all products, which may contain… more
- Fallon Health (Worcester, MA)
- …us on Facebook, Twitter and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance ... other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH Appeals… more
Related Job Searches:
Appeals,
Appeals Grievance Manager,
Director Grievance Appeals,
Grievance Appeals Analyst,
Grievance Appeals Coordinator,
Grievance Appeals Representative,
Grievance/appeals Analyst II,
Manager Grievance Appeals RN,
Manager II Grievance Appeals,
Specialist Grievance Appeals