- Harbor Health Services, Inc. (Mattapan, MA)
- …and consistency of decisions. Supervisory responsibilities for UM RN, Quality Analyst , Appeals and Grievances Specialist. Requirements: Bachelor's Degree ... of quality measures and other data by the Quality Analyst for report to regulatory agencies, including CMS and...all aspects of managed care medical management including UM/CM, Grievance and Appeals , inpatient and outpatient services,… 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 ... 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
- Point32Health (FL)
- …general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst is responsible per State and Federal regulations ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… 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, ... Medicare-Medicaid Program (MMP), and Medicaid lines of business. Analyst must identify trending issues on an ongoing basis and provide root/cause analysis when… more
- Point32Health (Canton, MA)
- …direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible per State and Federal regulations ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
- CVS Health (Hartford, CT)
- …(PO) is responsible for leading the MHK product development and configuration for the Grievance & Appeals (G&A) Department. This role contributes to the product ... vision and translate it for the product development team. They are responsible for team backlog development and prioritization, maintaining integrity of features or components, and collaborating closely with Engineering, Design, and other members of the team.… more
- CVS Health (St. Paul, MN)
- …obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals , SIU, etc. + Coordinates provider status information ... data within Aetna QNXT. + Team will also include provider operations analyst and potential pre-cred support for implementation activities. + Provides assistance and… more
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