- CenterWell (Washington, DC)
- **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
- Elevance Health (Washington, DC)
- …an accommodation is granted as required by law._ The **Manager II Grievance & Appeals ** responsible for management oversight of grievances and appeals ... departmental units to investigate, resolve, and respond to grievances and appeals , manages inventory and production...degree and a minimum of 5+ years grievance & appeals experience and a minimum of 3 … more
- Cognizant (Washington, DC)
- …or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances , precertification, initial and concurrent reviews . ... . Maintain working knowledge of applicable health insurers' internal claims, appeals , and retro-authorization as well as timely filing deadlines and processes.… more
- Somatus (Mclean, VA)
- …the Regulatory and Accreditation Team to ensure compliance with audits, complaints/ grievances , and adherence to contractual obligations and Service Level Agreements ... client pre-delegation audits, annual client audits, development of grievance and appeals workflow processes, and other regulatory requirements. + Direct, implement,… more
- Justice, Bureau of Prisons/Federal Prison System (Washington, DC)
- …Some examples of this qualifying experience are: GS-13: Experience investigating grievances submitted as administrative remedy appeals , regarding Women and ... of the total possible points for the vacancy KSAs or competencies; and 3 . Submit the appropriate documentation to support your CTAP eligibility. NOTE: Applicants… more