- Humana (Indianapolis, IN)
- **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
- Conduent (Hamilton, NJ)
- …a culture where individuality is noticed and valued every day. Fair Hearing Appeals Agent $18.50/ Hourly Onsite- Hamilton, NJ Full-time and Full Benefits **Location ... experienced healthcare (Medicaid & CHIP) call-center based customer service representative to process requests for an appeal (Fair Hearings...for an appeal (Fair Hearings for Plan A and Grievances for Plans B, C, and D) in a… more
- Sacramento Municipal Utility District (Sacramento, CA)
- …reports and disciplinary documents + Experience responding to grievances or appeals and serving as an employer representative in administrative hearings + ... and managerial personnel, and union representatives, to investigate and resolve grievances . Advises, consults with, and prepares response for management in … more
- Humana (Frankfort, KY)
- …Providers / Specialists, benefit coverages, authorizations, Provider claims inquiries, grievances and appeals , transportation needs, and pharmacy support. ... in a best-in-class contact center. As a Call Center Representative 2, you will provide coverage for **Eastern Time...questions being asked. + Escalates unresolved and pending member grievances and appeals . Decisions are typically focused… more
- Humana (San Juan, PR)
- …service for a range of issues from ordering durable medical equipment to grievances and appeals . Responsibilities include: + Recording the details of inquiries, ... outcomes working in a best-in-class contact center. The Bilingual Inbound Contacts Representative represents the company and our CarePlus team by addressing incoming… more
- Veterans Benefits Administration (Philadelphia, PA)
- Summary The Supervisory Veterans Service Representative (AVSCM) position is located in the VBA Philadelphia Regional Office, Philadelphia, PA. The Assistant Pension ... by VA and other agencies. Responsibilities The Supervisory Veterans Service Representative (Assistant Pension Management Center Manager) shares in the responsibility… more
- CVS Health (High Point, NC)
- …claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals . + Initiates out-reach/welcome calls to ensure constituents ... expectations are met or exceeded. + Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase… more
- State of Colorado (Colorado Springs, CO)
- …and techniques or recommend adjustments to policy and functions or services; INVESTIGATIONS/ GRIEVANCES + Serve as the initial contact and liaison for intake and ... + Assist in conducting objective and thorough internal investigations of grievances and complaints, and assist in recommending appropriate action; + Review… more
- City of New York (New York, NY)
- …jurisdiction of the Department of Correction" - Investigate serious incidents - Review grievances from people in custody and staff - Evaluate the performance of the ... perform other duties as determined by the General Counsel. Appeals Under the Board's Minimum Standards, whenever DOC decides...requirement applies to you, please discuss with the agency representative at the time of interview. WORK LOCATION: 2… more
- State of Colorado (CO)
- …Provide professional guidance to appointing authorities and employees regarding grievances , 1450-05 and appeal processes; + Investigate complaints of discrimination ... policy, State Personnel Board Rules, legal precedence, and DOC performance standards. Appeals & Legal Case- Requests for Information + Exercise discretion and… more
- State of Colorado (Canon City, CO)
- …hours and pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces offender idleness and creates real life ... tools, equipment and procedures; + Resolve conflict and informal grievances a the lowest level possible; + If necessary,...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
- State of Colorado (Golden, CO)
- …development training (as available) + Resolves informal staff grievances . Provide formal/informal performance feedback. Initiate progressive discipline, in ... for all youth + Responds to and resolves youth grievances + Act as first public contact with agency...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
- State of Colorado (Greeley, CO)
- …development training (as available) + Resolves informal staff grievances . Provide formal/informal performance feedback. Initiate progressive discipline, in ... for all youth + Responds to and resolves youth grievances + Act as first public contact with agency...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
- Centene Corporation (Atlanta, GA)
- …and medical care management programs, integrate physician services, quality assurance, appeals and grievances , and regulatory compliance programs with medical ... outcomes, continual improvement and performance enhancement. + As a representative of the Health Net Plan, assists in maintaining...+ Leads and/or supports resolution of member or provider grievances and appeals + Optimizes utilization of… more
- State of Colorado (Lakewood, CO)
- …development training (as available) + Resolves informal staff grievances . Provide formal/informal performance feedback. Initiate progressive discipline, in ... for all youth + Responds to and resolves youth grievances + Act as first public contact with agency...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
- Maryland Department of Transportation (Anne Arundel County, MD)
- …of Transportation for Second Step grievance appeals and disciplinary action appeals . + Negotiating the dispositions of grievances or disciplinary actions ... appeals (eg, stipulated agreements, withdrawal of charges for termination and resignations) with Represented employees and Attorneys. The current vacancy exists at MDOT TSO in the Office of Human Resources, which is located in Hanover, MD. (Anne Arundel… more
- State of Colorado (Denver, CO)
- …practices. + Ensures that youth are provided confidential access to grievances , medical assistance, and mental health assistance as needed/requested without staff ... 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
- VNS Health (Manhattan, NY)
- …solutions for complex cases, reviews prior authorizations/denial of services, and grievances and appeals . Participates in weekly care management/UM rounds ... to enhance effective delivery of care and member/provider satisfaction.* Acts as a representative of the VNS Health Plans and an advocate for the community through… more
- State of Colorado (Grand Junction, CO)
- …as required. Ensure that youth are provided confidential access to grievances , medical and behavioral health services as needed/requested. Distribute youth ... 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
- State of Colorado (Golden, CO)
- …as required. Ensure that youth are provided confidential access to grievances , medical and behavioral health services as needed/requested. Distribute youth ... 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