- Molina Healthcare (Boise, ID)
- …and evaluate appeal and grievance request to identify and classify member grievances , hand-off to appropriate department for appeals ; regulatory complaints as ... for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member grievances… more
- Molina Healthcare (Lincoln, NE)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. +… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to learn the specialty… 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 ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist III will receive, investigate and resolve member… 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 ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and ... as well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is… 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 ... Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for assisting the Appeal and Grievances… 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 ... Summary The Customer Solution Center (CSC) Appeals and Grievances (A&G) Training Development Specialist III plays a key role in enhancing employee skills,… 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...+ Communicate and work collaboratively with AG Representatives, Resolution Specialist and Management to maintain and improve quality of… more
- Baylor Scott & White Health (Temple, TX)
- …and/or level **Job Summary** **Hybrid position - limited time working onsite** The Appeals and Grievance Specialist reviews member and provider complaints, ... resolution of cases. They also review, research, and coordinate complaints, grievances , appeals , and reconsiderations following statutory and federal guidelines.… more
- LA Care Health Plan (Los Angeles, CA)
- …Center Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: ... call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This… more
- State of Colorado (Pueblo, CO)
- …employment laws; progressive discipline; records management; recruitment; responding to grievances , appeals , charges of discrimination; reorganization issues; ... HR Business Partner- HUMAN RESOURCES SPECIALIST II Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4972604) Apply HR Business Partner- HUMAN… more
- Independent Health (Buffalo, NY)
- …responsible for the collection and review of medical records specific to quality complaints/ grievances and appeals as indicated in support of a high performing ... plan and physician network. The Clinical Reviewer will investigate quality complaints/ grievances and appeals , document research of initial coverage… more
- COOLSOFT (Columbus, OH)
- …solution to meet CMS grievance system requirements for all FFS waivers & SPBM Grievances & Appeals , address MCP grievance data storage and analytics needs ... APEX SOQL JavaScript SFDC Sales Force Management Specialist (Jobs in Columbus, OH) Requirement id 153803...for Jan 1st, 2026 go-live date for receiving submitting Grievances & Complaints in the system directly. Responsibilities *… more
- Commander, Navy Installations (Bangor, WA)
- …civilian personnel policies and procedures in labor relations matters (eg, discipline, grievances , appeals , fair employment practices). You will evaluate human ... Summary You will serve as a SUPERVISORY HUMAN RESOURCES SPECIALIST (EMPLOYEE AND LABOR RELATIONS) in the Human Resource Office of COMMANDER, NAVY REGION NORTHWEST.… more
- Department of State - Agency Wide (Washington, DC)
- …and management official related to discipline, adverse actions, performance-based actions, grievances , appeals and other third-party actions. There is no ... applicants who respond to this flyer. Responsibilities As a Human Resource Specialist (Employee Relations) at a minimum you will ensure the effective administration… more
- LA Care Health Plan (Los Angeles, CA)
- …and smooth business operations. Analyzes and resolves complex problems dealing with grievances and appeals . Provide policy and procedure interpretation and ... Behavioral Health Operations Specialist II Job Category: Clinical Department: Behavioral Health...achieve that purpose. Job Summary The Behavioral Health Operations Specialist II is responsible for supporting, coordinating and facilitating… more
- Arab Community Center for Economic and Social Serv (Dearborn, MI)
- …to access services and rights processes + Assist with resolution of local complaints, grievances , and appeals processes + Survey, track, trend, and report on ... Intake & Customer Service Specialist Department: Community Health & Research Center Location: Dearborn, MI START YOUR APPLICATION… more
- Tufts Medicine (Boston, MA)
- …a variety of areas including employee discipline/corrective action and employee appeals and the grievance process. 2. Develops and modifies Employee Relations ... 5. Provides union contract administration including the investigation of grievances , drafting grievance responses, MOA preparation. 6. Coordinates and prepares… more
- United States Fleet Forces Command (VA)
- Summary You will serve as a HUMAN RESOURCES SPECIALIST (CLASSIFICATION) in the FLEET HUMAN RESOURCES OFFICE of NORFOLK NAVAL SHIPYARD. Responsibilities You will ... in classification may possibly create qualification problems or result in grievances . You will resolve conflicts; analyze and anticipate potential problems and… more