- Humana (San Juan, PR)
- **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
- Humana (Atlanta, GA)
- …us put health first** Become a valued member of Humana's Internal Review Team as a Grievances & Appeals Representative , where you will play a critical role ... you will perform thorough reviews of clinical documentation to assess whether grievances , appeals , or additional requests are justified, and provide final… 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
- Point32Health (Canton, MA)
- …responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for ... (https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance… more
- Robert Half Accountemps (Eden Prairie, MN)
- Description Clinical Appeals Representative (Contract - Fully Remote) We're seeking a detail-oriented Clinical Appeals Representative to join our team on ... health insurance operations by managing documentation, coordinating with providers, and ensuring appeals and grievances are processed accurately and on time.… more
- Fallon Health (Worcester, MA)
- …other applicable regulatory requirements and member and provider expectations. The FH Appeals and Grievances Triage Administrator serves to administer the FH ... standards. The Triage Administrator is responsible for triaging and assigning all incoming appeals and grievances addressed to the Member Appeals &… more
- Adecco US, Inc. (Ontario, CA)
- Adecco Medical & Science is hiring a REMOTE Clinical Appeals Representative for a healthcare organization based in Ontario, CA! This is a 100% remote opportunity ... as the point of contact for Health Plan member grievances and potential quality of care issues (PQIs) *...* Coordinate the intake and initial processing of member grievances and quality of care concerns from internal and… more
- TEKsystems (Honolulu, HI)
- …Honolulu** We are seeking a detail-oriented and customer-focused professional to support Appeals & Grievances team. This role involves handling sensitive member ... and determine appropriate actions based on policies and regulations. + Analyze appeals , grievances , and inquiries using contractual and regulatory guidelines. +… 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
- 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
- State of Colorado (Canon City, 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
- Transdev (Dorchester, 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
- Navy Exchange Services (NEX) (Bethesda, MD)
- …discipline. Provides guidance and assistance to management on disciplinary actions, grievances , and appeals . Ensures appropriateness of charges and penalties. ... across the entire workforce. Supervises subordinate exempt Human Resources Representative . Duties and Responsibilities: - As District Human Resources Managers,… more
- State of Colorado (Pueblo, CO)
- …and disciplinary actions, signing performance plans and appraisals, and resolving informal grievances at the lowest level. + Draft and deliver Confirming Memos, Plan ... + Attends all assigned meetings or sends a nursing representative . + The Relief Pool and Ambulatory Clinic Manager...if your application is eliminated. You will find the appeals process, the official appeal form, and how to… more
- State of Colorado (Pueblo, CO)
- …and disciplinary actions, signing performance plans and appraisals, and resolving informal grievances at the lowest level. + Draft and deliver Confirming Memos, Plan ... + Attends all assigned meetings or sends a nursing representative . + The NM provides guidance and direction for...if your application is eliminated. You will find the appeals process, the official appeal form, and how to… more
- State of Colorado (Grand Junction, CO)
- …develops clinical programs, manages budgets, and serves as an administrative representative during emergencies. Additionally, as a Behavioral Site Director, you can ... to staff, including hiring, training, evaluations, disciplinary actions, and resolving grievances . - Direct staff resources to ensure effective delivery of… 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 (Jefferson County, CO)
- …management plan reviews (PMPs). + Determines and responds to Step 1 grievances if staff supervised initiates a formal grievance. + Observes the individual ... if your application is eliminated. You will find the appeals process, the official appeal form, and how to...State Personnel Board (https://spb.colorado.gov/) website. + You or your representative must sign and submit the official appeal form… more
- State of Colorado (Chaffee County, CO)
- …to ensure adequate transmissions to outlying facilities; + Research co-pay grievances , request credit/refund as necessary from HQ authority; + Attends mandatory ... 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