- Humana (Helena, MT)
- …determine if an a grievance , appeal or further request is warranted. The Appeals Representative 4 + Review documents + Building cases + Inventory Management ... of our caring community and help us put health first** The Appeals Representative 4 Investigates and resolves member and practitioner issues. manages client… more
- Point32Health (MA)
- …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
- AmeriHealth Caritas (Newark, DE)
- …of medical management authorizations.; + Research and Investigate member and/or provider appeals and grievance requests, including review of UM/claim denial ... system and documents, all correspondence with a member/participant, representative and/or a provider, related to an appeal or...Care environment + 1 to 3 years' experience in grievance / appeals environment required **The Ideal Person will… more
- LA Care Health Plan (Los Angeles, CA)
- …Required: At least 5 years of experience resolving health care eligibility, access, grievance and appeals issues, preferably in health services, legal services ... Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, US,… more
- Humana (Baton Rouge, LA)
- …of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties… more
- Independent Health (Buffalo, NY)
- …ICD-9-CM, ICD-10-CM and HCPCS coding preferred. + Experience in compliance regulations, appeals and grievance knowledge preferred. + Ability to effectively ... and 5pm** **Monday through Friday** . **Overview** The Provider Relations Representative will be responsible for assisting our provider constituents and providing… more
- MTA (New York, NY)
- Senior Labor Relations Representative Job ID: 12716 Business Unit: MTA Headquarters Location: New York, NY, United States Regular/Temporary: Regular Department: ... Date Posted: Aug 15, 2025 Description JOB TITLE: Senior Labor Relations Representative DEPT/DIV: Labor Relations WORK LOCATION: 420 Lexington Ave FULL/PART-TIME FUL… 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 ... standards, other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH… more
- CVS Health (Hartford, CT)
- …Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. Educates ... do it all with heart, each and every day. **Position Summary** Customer Service Representative is the face of Aetna and impacts members' service experi‐ ence by… more
- CVS Health (Phoenix, AZ)
- …-Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. -Educates ... work in Arizona. Responsibilities below include, but not limited to: -Customer Service Representative is the face of Aetna and impacts members' service experience by… more
- CVS Health (Montgomery, AL)
- …-Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. -Educates ... we do it all with heart, each and every day. **Description** -Customer Service Representative is the face of Aetna and impacts members' service experience by manner… more
- BrightSpring Health Services (Knoxville, TN)
- …to Member and Provider issues. Refer all unresolved issues to the next level including grievance and appeals . + Actively market plan to new senior care partners ... Our Company Signature Advantage Overview Seeking a Sales Account Representative /Executive for our Signature Advantage Plan who will work with senior care partners to… more
- CVS Health (Olympia, WA)
- …contract. + Process claim referrals, new claim handoffs, nurse reviews, provider complaints, grievance and appeals via target system. + Assists providers with ... credentialing/re-credentialing and contracting questions and issues. + Assist in compiling claim data for audits. Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal… 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
- City of New York (New York, NY)
- …contractual issues that may arise with CFB employees. - Serve as the CFB's grievance representative and administer the contractual grievance process. Serve ... as Hearing Officer for grievances and disciplinary appeals . Represent the agency at hearings before the Office of Labor Relations and arbitration sessions at the… more
- State of Colorado (Denver, CO)
- …and quality. The position monitors the team's performance in reviewing grievance information, auditing providers and completing investigations. In this role, the ... 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
- New York State Civil Service (Albany, NY)
- …rules, regulations and case law. The incumbent serves as the Chancellor's representative in hearing appeals of disciplinary and contract grievances pursuant ... relations policy for classified service employees.- Serves as the University's representative in the administration of the grievance procedures (contract,… more
- CUNY (New York, NY)
- …immigration. The Special Counsel serves as hearing officer of disciplinary and grievance proceedings and represents the College at higher levels of the disciplinary ... and grievance processes. The Special Counsel also serves as the...grievances and disciplinary proceedings as well as student disciplinary appeals ; advocates the College's position at appeal hearings. -… more
- State of Colorado (Pueblo, CO)
- …referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance with DOC Administrative ... 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
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …and member services to resolve clinical and administrative issues. + Support the appeals and grievance process by preparing clinical rationales and participating ... collaboration in behavioral health settings. _The Physical Demands described here are representative of those that must be met by an employee to successfully… more
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