- Humana (Baton Rouge, LA)
- **Become a part of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by ... trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced… 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, ... required to achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and… more
- AmeriHealth Caritas (Newark, DE)
- …more about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances , this position is responsible for the ... complaints/issues to management + Monitors to ensure that all problems with appeals / grievances presented by plan members/participants are resolved in accordance… more
- Adecco US, Inc. (Ontario, CA)
- Adecco is assisting a local client recruiting for Clinical Appeals Representative opportunities in Ontario, CA (90% remote). This is an excellent opportunity to ... an impact in the healthcare industry. If a Clinical Appeals Representative role sounds like something you...to: + Serve as point of contact for member grievances and potential quality of care issues + Process… more
- Point32Health (MA)
- …responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for ... + Must be able to organize, plan and implement the functions of Member Appeals and Grievances , maintain timelines and turnaround times to meet multiple… more
- Commonwealth of Pennsylvania (PA)
- Appeals Referee Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5055524) Apply Appeals Referee Salary $77,379.00 - $117,497.00 Annually ... of Labor & Industry is excited to welcome an Appeals Referee to our dedicated team in the Hermitage...the office, as well as resolve any complaints or grievances received. Work also includes a variety of administrative… more
- MTA (New York, NY)
- …and participate in monthly conferences with union representatives to discuss contract grievances and employee discipline appeals ; perform analytical review of ... Senior Labor Relations Representative Job ID: 12716 Business Unit: MTA Headquarters...Aug 15, 2025 Description JOB TITLE: Senior Labor Relations Representative DEPT/DIV: Labor Relations WORK LOCATION: 420 Lexington Ave… more
- Fallon Health (Worcester, MA)
- …of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and ... assigning all incoming appeals and grievances...acknowledgement of the grievance/appeal, educating the member and/or member representative about the grievance/appeal, gathering all pertinent and relevant… more
- CVS Health (Salem, OR)
- …claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals . + Initiates out-reach/welcome calls to ensure constituents ... heart, each and every day. **Position Summary:** Health Concierge -Customer Service Representative is the face of Aetna to provide targeted, personalized service… more
- CVS Health (High Point, NC)
- …claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals . + Initiates out-reach/welcome calls to ensure constituents ... expectations are met or exceeded. + Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase… more
- State of Colorado (Sterling, CO)
- …hours and pay, creates, schedules, and assigns tasks, and resolves informal grievances according to agency policy while reducing inmate idleness and creating real ... daily monitoring, performance management (planning, reviewing and evaluating), resolving complaints/ grievances at the informal level, responsibility for scheduling and… more
- State of Colorado (Denver, CO)
- …aggregate summary data as requested to the BHA Advisory Council on provider grievances , quality data, or other items as appropriate. Policy, Essential Safety Net ... 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
- Transdev (Readville, MA)
- …of internal policies and procedures and regulations for accurate resolution of appeals , complaints, and grievances . + Understand legal requirements and ... + Manage the grievance process and provide comprehensive responses to complaints, grievances , and arbitrations that support the Company's decision and comply with… more
- State of Colorado (Pueblo, CO)
- …outlined by the Pueblo Regional Center. Addresses all complaints and resolving individual grievances at the home level. When a resident is placed in an ... QMAP with check off completed by Designated Regional Center representative or earn QMAP within 3 months of hiring...by the State Personnel Director. You will find the appeals process, the official appeal form, and how to… more
- City of New York (New York, NY)
- … and administer the contractual grievance process. Serve as Hearing Officer for grievances and disciplinary appeals . Represent the agency at hearings before the ... play a key role in managing internal labor relations investigations, union grievances , and collective bargaining agreements and engagement with Union Partners, and… more
- State of Colorado (Denver, CO)
- …inmate hours and pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness, and creates real life ... 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
- State of Colorado (Pueblo, CO)
- …+ Ensures staff are trained to perform successfully. + Facilitates employee grievances . + Begins the hiring process, interviews applicants, and recommends hires, ... Board or request a review by the State Personnel Director. You will find the appeals process, the official appeal form, and how to deliver it on the State Personnel… more
- State of Colorado (Sterling, CO)
- …inmate hours and pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness and creates real life ... 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
- State of Colorado (Denver, CO)
- …hours and pay, creates schedule and assigns tasks and resolves informal grievances ; inspects work and performs inmate evaluations; reduces inmate idleness and ... 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
- State of Colorado (Chaffee County, CO)
- …employee evaluations and plans; conducts performance evaluations, resolves informal grievances ; creates schedules, assigns tasks, inspects work; approves time, ... 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
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