- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... complaints, appeals and grievance cases for products for all lines of business. Responsibilities include, but are not limited to: timely classification and… more
- VNS Health (Manhattan, NY)
- …issues pertaining to State Fair Hearings. Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents arguments in defense ... + Enters data and assists with compiling reports and analysis on the grievance and appeals process. For Fair Hearings: + Supports Grievance and Appeals… more
- VNS Health (Manhattan, NY)
- …criteria. + Enters data and assists with compiling reports and analysis on the grievance and appeals process. + Participates in special projects and performs ... experience in health care, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management required +… more
- Commonwealth Care Alliance (Boston, MA)
- …to appeal and grievances. **What You'll Be Doing:** - Processing of Grievances & Appeals . - Responsible for the progress of grievance and appeal intervention and ... pharmacy, dental, reporting, and member services. - Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in day-to-day tasks and assignments.… more
- LA Care Health Plan (Los Angeles, CA)
- …meet and/or exceed member satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring work, providing ... assisting with the development of a successful and cohesive Appeals and Grievance unit, with a high...and or process improvement. Assist Supervisor to ensure that Specialist provide accurate, timely, and quality responses. Ensure that… more
- BayCare Health System (Clearwater, FL)
- …be working remotely? Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Grievance Specialist -Health Plan **Location** Clearwater:Park Place | ... to regulatory requirements. + Triage, plan, and execute intake of Appeals and Grievance submissions. + Keeping track of deadlines, ensuring all necessary… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... 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
- Medical Mutual of Ohio (Brooklyn, OH)
- …will consider collective experience, training and education. . 5 years as an Appeals Specialist or equivalent experience in Medicare health insurance claims, ... areas to implement those changes. **Responsibilities** . Reviews and evaluates appeal/ grievance requests and electronic inquiries in order to identify and classify… more
- UCLA Health (Los Angeles, CA)
- Description As the Appeal & Grievance Specialist , you will be responsible for: + Managing the intake and resolution of member and provider appeals and ... + Working closely with medical director and appeal & grievance team to ensure that all cases are handled...operations, managed care, or Medicare Advantage, specifically in handling appeals and grievances preferred * Experience in interpreting CMS… more
- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and ... grievance process that meets state, federal, accreditation and other...knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests,… more
- Molina Healthcare (GA)
- …+ 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
- Maryland Department of Transportation (Baltimore City County, MD)
- Labor Relations Specialist (Administrator III) Salary $69,323.00 - $112,044.00 Annually Location Baltimore City Job Type Full Time Job Number ... + Benefits + Questions Description MARYLAND TRANSIT ADMINISTRATION Labor Relations Specialist (Administrator III) (2588) Grade 18 Career Service Open to all… more
- Henry Ford Health System (Grand Blanc, MI)
- …facilities and locations as needed. As a strategic partner, the Labor Relations Specialist provides HR and Labor Relations support to leaders and associates within ... active participation in the negotiations of collective bargaining agreements, manage grievance procedures to handle complaints from unionized employees, and advise… more
- Office of Human Resources Management (IN)
- Summary As a Human Resources Specialist , you will be responsible for providing advice and guidance to management and employees regarding the full range of employee ... be filled as needed. Responsibilities As a Human Resources Specialist , you will perform the following duties: Serve as...prepare agency position or rebuttals on hearings and record appeals . Address complex issues and questions pertaining to hours… more
- US Marine Corps (Arlington, VA)
- Summary You will serve as a Human Resources Specialist (ER/LR) in the Administrative and Resources Division of HQ US MARINE CORPS. Responsibilities You will serve as ... a Labor and Employee Relations staff specialist with responsibility for assisting in planning and implementing...draft formal correspondence on disciplinary and adverse actions, and appeals . You will represent the Human Resources Branch in… more
- New York State Civil Service (Albany, NY)
- …Homeland Security and Emergency Services, Division of Title Human Resources Specialist 3 Labor Relations Occupational Category Other Professional Careers Salary ... agency.*Strong public speaking and presentation skills. Duties Description The Human Resources Specialist 3 Labor Relations (HR Spec 3 LR) will report directly to… more
- Elevance Health (Norfolk, VA)
- …of customer service and manages adjustments, ITS processing, keying, rate negotiation, grievance and appeals , escalations, etc., in providing a seamless Blue ... **Title: Plan to Plan Service Specialist I** **Location:** This position will work a...internal business partners (sales, member experience, claims, medical review, appeals , etc.) and external contacts within the other Blues… more
- New York State Civil Service (Albany, NY)
- …Homeland Security and Emergency Services, Division of Title Human Resources Specialist 1 Labor Relations/Trainee 1/Trainee 2 (NY HELPS) Occupational Category Other ... the appropriate level** based on their experience and education.**Human Resources Specialist 1 Labor Relations level requirements:*Human Resources Specialist … 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 (Denver, 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 , Ana Andersen at doc_###@state.co.us or call ### ALL… more