- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and ... of cases; review, research and coordination of complaints, grievances, appeals and reconsiderations consistent with statutory and federal regulatory guidelines.… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and ... stakeholders, without breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit projects and other… more
- Intermountain Health (Des Moines, IA)
- **Job Description:** The RCO Appeals Hearing Specialist is responsible for investigating, coordinating and managing legal insurance cases and represents ... and works closely with Intermountain Health legal team, Physician Advisors, and Appeals RN consultants in their various capacities. **We are committed to offering… 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 ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- Molina Healthcare (San Antonio, TX)
- …claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, ... and Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or authorized… 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 and related ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance … more
- Tufts Medicine (Boston, MA)
- …involving a variety of areas including employee discipline/corrective action and employee appeals and the grievance process. 2. Develops and modifies Employee ... research breakthroughs to life. **Job Overview** The Senior Employee & Labor Relations Specialist serves as a trusted subject matter expert and strategic partner to… more
- Cedars-Sinai (CA)
- …CSHS employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process, etc. + Remains updated ... **Job Description** The Managed Care Compliance Specialist is responsible for assisting with the implementation...ID** : 11981 **Working Title** : Managed Care Compliance Specialist - Managed Care **Department** : MNS Managed Care… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …referrals generated to care management programs + Provides administrative support to the grievance and appeals process within the + Medical Services department ... Depending on the specific tasks assigned, the Medical Services Coordination Specialist provides administrative support for any of the programs of Utilization… more
- Johns Hopkins University (Baltimore, MD)
- …actions and make sound recommendations to management. + Manage the grievance process, including fact finding, reviewing evidence, serving as hearing officer, ... as an advisor to employees and management on employee appeal and grievance issues. + Work in partnership with department management regarding appropriate… more
- State of Colorado (CO)
- …referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance with DOC Administrative ... of the department's action. For more information about the appeals process, the official appeal form, and how to...position, please direct your inquiries to our Employee Relations Specialist , Kristen Lange , at doc_###@state.co.us or call ###… more
- State of Colorado (Fremont County, CO)
- …providing opportunities for offenders to receive feedback, crisis intervention, and grievance resolution; + Stresses results oriented direction in guiding offender ... of the department's action. For more information about the appeals process, the official appeal form, and how to...position, please direct your inquiries to our Employee Relations Specialist , Kristen Lange , at doc_###@state.co.us or call ###… more
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