- Centene Corporation (Indianapolis, IN)
- …member and provider complaints, grievances and appeals + Maintain files on individual appeals and grievances + May coordinate the Grievance and Appeals ... High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals , claims, related managed care experience, or… more
- AmeriHealth Caritas (Philadelphia, PA)
- …oversee daily operations, staffing, and performance for a remote team of 15 Appeals & Grievance Specialists, Administrator, and Team Leads supporting our ... Pennsylvania Medicaid business. This role ensures that all provider appeals and grievance cases are processed accurately, timely, and in full compliance with… more
- AmeriHealth Caritas (Philadelphia, PA)
- …. **This position is hybrid in Philadelphia, PA** **Job Summary** The Appeals & Grievance Case Resolution Specialist is responsible for the ... full life cycle of assigned member and/or provider appeals and grievance cases. Working under general supervision, this role conducts case intake, investigation,… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …protected characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Appeals & Grievance Liaison Associate Location: Remote Career Area: Customer ... an important expansion of our job family structure within Appeals & Grievances. The position will offer visibility into...Grievances. The position will offer visibility into the entire appeals process, but it will focus on the most… more
- Point32Health (FL)
- …Point32Health (https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
- Point32Health (MA)
- …(https://www.point32health.org/) . **Job Summary** SUMMARY Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
- CVS Health (Hartford, CT)
- …AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. * Health Plan Experience Highly ... of this Medical Director role are related to Medicare Appeals :** * Direct daily work on part C ...Appeals :** * Direct daily work on part C appeals (both provider and member/nonparticipating providers) * Provide direct… more
- LA Care Health Plan (Los Angeles, CA)
- …the Clinical Programs. + Develop and execute on strategic opportunities to improve the overall appeals & grievance process. Create a best in clinical appeals ... experience with at least 3 years of experience with health care grievance and/or appeals issues, preferably in a managed care or Medicaid Health Plan environment… more
- Elevance Health (FL)
- …by medical directors and consultants; preparing recommendations to uphold or deny appeals ; and ensuring all grievance processes are completed within regulatory ... and/or paralegal experience is strongly desired. + Understanding of the grievance and appeals process is strongly preferred. + Basic knowledge of Medicare and… more
- CareFirst (Baltimore, MD)
- …The Appeals Specialist I is responsible for the initial analysis of appeals and grievance correspondence, and determination of next steps for Commercial and ... II and III with unit projects and other duties related to the appeals , grievance and/or reconsideration processes. Communicates with Supervisor to offer feedback… more
- Molina Healthcare (Houston, TX)
- …claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, ... **Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances, and/or complaints from Molina members, providers, and… more
- LA Care Health Plan (Los Angeles, CA)
- …RN is responsible for assisting with the development of a successful and cohesive Appeals and Grievance (A&G) clinical unit. This position is responsible for the ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position… more
- CVS Health (Oklahoma City, OK)
- …of responses from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance . Identify trends and emerging issues and ... report and recommend solutions. -Research incoming electronic appeals , complaints and grievance to identify if appropriate for unit based upon published business… more
- CVS Health (Sacramento, CA)
- …carrying a modified case load including but not limited to:-Research incoming electronic appeals , complaints and grievance to identify if appropriate for unit ... resource and reroute inappropriate work items that do not meet appeals , complaints and grievance criteria. + Research Standard Plan Design or Certification of… more
- Fallon Health (Worcester, MA)
- …us on Facebook, Twitter and LinkedIn. **Brief summary or purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance ... other applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH Appeals… more
- Fallon Health (Worcester, MA)
- …us on Facebook, Twitter and LinkedIn. **Brief summary of purpose:** Fallon Health (FH) Appeals and Grievance process is an essential function to FH's compliance ... and Grievances Triage Administrator serves to administer the FH Appeals and Grievance process as outlined in the FH Member Handbook/Evidence of Coverage,… more
- Humana (Washington, DC)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational committees.… more
- Humana (Raleigh, NC)
- …roles include an overview of coding practices and clinical documentation, dispute, grievance , and appeals processes, and outpatient services and equipment, ... member population, or condition type. May also engage in dispute, grievance , and appeals reviews. May participate on project teams or organizational committees.… more
- Humana (Carson City, NV)
- …Some roles include an overview of coding practices and clinical documentation, dispute/ grievance and appeals processes, and outpatient services and equipment, ... diagnoses and care received. May also engage in disputes and grievance and appeals reviews. May participate on project teams or organizational committees.… more
- MyFlorida (Tallahassee, FL)
- …+ Handle Grievances and Legal Documents: Research and respond to inmate grievance appeals related to classification issues. Prepare documents and affidavits ... for court petitions involving classification issues when requested by the Office of the General Counsel. + Training and Support: Develop training courses and lesson plans for new Classification Officers, including scheduling and logistics. Provide guidance,… more