- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I...members. It will support the Appeals and Grievances team to receive, investigate and resolve member… more
- LA Care Health Plan (Los Angeles, CA)
- …Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider complaints and ... Customer Solution Center Appeals and Grievances Specialist ...experience in Managed Care with specific experience in resolving member and provider complaint and appeals issues,… more
- Molina Healthcare (Everett, WA)
- …CA Medi-Cal and Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or ... **Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers,… more
- Molina Healthcare (Fort Worth, TX)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance… more
- Molina Healthcare (AZ)
- …with research. * Determines appropriate language for letters and prepares responses to member appeals and grievances . * Elevates appropriate appeals ... problem-solving in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with… more
- Molina Healthcare (GA)
- **JOB DESCRIPTION** **Job Summary** Responsible for reviewing and resolving Medicare member appeals and Medicare claims in communicating resolution to members ... + Responsible for the comprehensive research and resolution of the appeals from Molina members, providers and related outside agencies to ensure… more
- Baylor Scott & White Health (Temple, TX)
- … and Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and grievance cases for products for ... and resolution of cases; review, research and coordination of complaints, grievances , appeals and reconsiderations consistent with statutory and federal… more
- US Marine Corps (Quantico, VA)
- …investigations and leave administration. Performs and reviews trend analysis of grievances , unfair labor practices, complaints, and appeals , and develops ... be considered in effecting disciplinary actions, removals, suspensions, and in resolving grievances and appeals related to formal disciplinary actions taken and… more
- Tufts Medicine (Boston, MA)
- …research breakthroughs to life. **Job Overview** The Senior Employee & Labor Relations Specialist serves as a trusted subject matter expert and strategic partner to ... role may delegate and oversee the work of the Employee & Labor Relations Specialist . This position requires deep knowledge of both employment and labor laws (eg,… more
- Insight Global (San Francisco, CA)
- …to change - thrives in a fast-moving, start-up environment Experience with grievances , appeals , or quality assurance within healthcare operations Background in ... Job Description Insight Global is seeking a Remote Operations Support Specialist to join our growing Food Operations team. This role supports the day-to-day… more
- Molina Healthcare (Green Bay, WI)
- …to healthcare premium. * Assist in resolution for escalated premium issues with Appeals and Grievances team members. * Guide and collaborates with enrollment ... party with the amount due for the healthcare program the member is enrolled. * Guide and support Member Service representatives to help them resolve member … more
- Commonwealth Care Alliance (Boston, MA)
- …schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and ... are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental… more
- The County of Los Angeles (Los Angeles, CA)
- …personnel in their unit and effectively recommending the adjustment of grievances and disciplinary problems. Other positions are assigned such functions as: ... first level technical and administrative supervision to the complaint or advanced-level appeals unit. Essential Job Functions + Supervises the activities of all… more
- State of Colorado (Canon City, CO)
- …Benefit Plan or PERA Defined Contribution Plan plus 401K and 457 plans. Member Contribution Rates . Correctional Officers I-IV qualify as "Safety Officers" and are ... hours and pay, creates, schedules, and assigns tasks, and resolves informal grievances according to agency policy while reducing inmate idleness and creating real… more
- State of Colorado (Pueblo, CO)
- …nursing directives using effective communication. + Collaborates with the Clinical Safety Specialist (CSS) in the event of safety and security needs, to ensure ... actions, signing performance plans and appraisals, and resolving informal grievances at the lowest level. + Draft and deliver...if your application is eliminated. You will find the appeals process, the official appeal form, and how to… more
- State of Colorado (Pueblo, CO)
- …nursing directives using effective communication. Collaborates with the Clinical Safety Specialist (CSS) supervisor in the event of safety and security needs, ... actions, signing performance plans and appraisals, and resolving informal grievances at the lowest level. + Draft and deliver...if your application is eliminated. You will find the appeals process, the official appeal form, and how to… more
- State of Colorado (Chaffee County, CO)
- …Plan or PERA Defined; + Contribution Plan plus 401K and 457 plans. Member Contribution Rates . Correctional Officers I-IV qualify as "Safety Officers" and are ... to ensure adequate transmissions to outlying facilities; + Research co-pay grievances , request credit/refund as necessary from HQ authority; + Attends mandatory… more
- State of Colorado (Denver, CO)
- …Plan or PERA Defined; + Contribution Plan plus 401K and 457 plans. Member Contribution Rates . Correctional Officers I-IV qualify as "Safety Officers" and are ... hours and pay, creates schedule and assigns tasks and resolves informal grievances ; inspects work and performs inmate evaluations; reduces inmate idleness and… more
- Actalent (Chattanooga, TN)
- …processes Job Responsibilities + Review and process medication-related prior authorizations, pharmacy appeals , and member grievances + Conduct prospective ... Pharmacist - Coverage Review Specialist (Remote) Location: Must reside within 2 hours...Federal regulations + Respond to prescriber, pharmacy provider, and member inquiries within established timelines + Build and maintain… more
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