- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Customer Solution Center Appeals and Grievances (Temporary) Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & ... Grievances Location: Los Angeles, CA, US, 90017 Position Type:...Job Summary The Supervisor, Customer Solution Center Appeals and Grievances is responsible for direct supervision and support of… 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, CA, US, ... that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage process for… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & ... Grievances Location: Los Angeles, CA, US, 90017 Position Type:...purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for… more
- Healthfirst (NY)
- …and Responsibilities:** + Conduct quality audits of A&G items cases grievances , pre-service appeals, and post service appeals utilizing appropriate sources of ... required to complete the audit. + Review and investigate appeals and grievances requests to ensure all requests are identified, classified, and fully resolved… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Training Development Specialist III Job Category: Administrative, HR, Business Professionals Department: CSC Appeals ... & Grievances Location: Los Angeles, CA, US, 90017 Position Type:...Job Summary The Customer Solution Center (CSC) Appeals and Grievances (A&G) Training Development Specialist III plays a key… more
- Molina Healthcare (Boise, ID)
- …Appeals Unit that is responsible for reviewing and resolving member grievances , regulatory complaints, Medicaid Fair Hearings and communicating resolution to members ... small group of employees responsible for submission, intervention and resolution of grievances , and/or complaints from Molina members and related outside agencies. +… more
- Trinity Health (Columbus, OH)
- …and Grievance Coordinator is responsible for the processing and resolution of appeals, grievances and disputes from members and providers **What You Will Do:** + ... Document all appeal requests or grievances upon receipt in the operating systems and routes...and review with clinical colleagues. + Screen all incoming grievances , appeals and provider claim dispute to ensure they… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist III Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist III will receive, investigate and resolve member and provider… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA-Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the Appeals ... and Grievances department through many NCQA and other related quality...+ Associate's Degree or equivalent experience in Appeals and Grievances **Desired Education:** + Bachelor's Degree (BS or BA)… more
- Elevance Health (Seattle, WA)
- …PST The **Manager II Grievance/Appeals** is responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to ... grievances and appeals, manages inventory and production levels, and...decisions, pharmacy on pre-service and post service appeals and grievances related to non-clinical and clinical services, quality of… more
- Molina Healthcare (Lincoln, NE)
- …for the comprehensive research and resolution of the appeals, dispute, grievances , and/or complaints from Molina members, providers and related outside agencies ... internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. + Requests… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider… more
- Humana (Little Rock, AR)
- …+ MD or DO degree + A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of ... assignment + Board Certified in an approved ABMS Medical Specialty + Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be… more
- Humana (Juneau, AK)
- …+ MD or DO degree + A current and unrestricted license in at least one state and willing to obtain license, as required, for various states in region of assignment + ... Board Certified in an approved ABMS Medical Specialty + **Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, Physical Medicine and Rehab, Anesthesiology or General Surgery trained** + Excellent written and communication skills + 5… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA-Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances team ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally,...member outreach as well as supports the Appeal and Grievances team in creation, review and mailing of member… more
- Northern Light Health (Bangor, ME)
- …addition, the incumbent will provide in person management of patient complaints and grievances at Acadia Hospital to meet their unique compliance and patient care ... The Patient Advocacy Program Manager understands trends related to complaints and grievances and collaborates with Patient Experience partners to promote a proactive… more
- Independent Health (Buffalo, NY)
- …for the collection and review of medical records specific to quality complaints/ grievances and appeals as indicated in support of a high performing health ... and physician network. The Clinical Reviewer will investigate quality complaints/ grievances and appeals, document research of initial coverage determinations, and… more
- Fallon Health (Worcester, MA)
- …applicable regulatory requirements and member expectations. The FH Member Appeals & Grievances Coordinator serves to administer the FH Appeals and Grievance process ... and procedures, and regulatory standards. The Member Appeals & Grievances Coordinator serves as a liaison between FH members...referrals, membership, and benefit issues as well as any grievances regarding quality of care or service. The Member… more
- Roper St. Francis (Charleston, SC)
- …Summary** **:** The Patient Relations & Legal Coordinator aids in complaints and grievances management as well as legal matters to include coordinating with outside ... complaints processes and CMS Conditions of Participation related to complaints and grievances preferred. Five years of experience in the legal field, customer… more
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