- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** Appeals and Grievances Representative supports the Operations Department and the Appeals and Grievances team in ... as well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is… more
- Elevance Health (Meridian, ID)
- **Title: Grievance/ Appeals Representative I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 ... miles of one of our PulsePoint locations. The **Grievance/ Appeals Representative I** is responsible for reviewing,...impact:** + Conducts investigation and review of customer grievances and appeals involving provision of service… more
- The Cigna Group (Bloomfield, CT)
- …not limited to:** + Ability to differentiate different types of requests Appeals , Grievances , coverage determination and Organization Determinations in order to ... documents, correct appeal types, timeframes and what is being appeals + Assign priority and internal due date based...criteria for reviewing and making decisions on all non-clinical appeals and validating the accuracy of all received information… more
- Commonwealth of Pennsylvania (PA)
- Appeals Referee Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/4709570) Apply Appeals Referee Salary $75,678.00 - $114,915.00 Annually ... of Labor & Industry is excited to welcome an Appeals Referee to our dedicated team! The primary focus...within the office, as well as resolves complaints and grievances . You will also supervise clerical support staff, prepare… 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
- Centers Plan for Healthy Living (Margate, FL)
- …in related area of responsibility, (ie utilization management, quality management, grievances , and appeals ) Type of Experience Required: Strong analytical ... RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate,...PHYSICAL REQUIREMENTS : The physical requirements described here are representative of those that must be met by an… 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
- Access Dubuque (Dubuque, IA)
- …to internal processing guidelines. + Assist in review and resolution of complaints, appeals and grievances as needed. + Complete all additional assigned projects ... Member Services Representative **Medical Associates** 1 Positions ID: oXDJufwx Posted...Health Plans is looking for a **full-time Member Services Representative ** to join our team! **Who You Are:** +… more
- Commonwealth Care Alliance (Boston, MA)
- …lines or medical setting preferred + Prior experience with service authorizations, grievances and appeals , scheduling medical appointments preferred + Ability to ... members and all those involved in CCA members' care. The Member Service Representative (MSR) is responsible to provide a best-in-class service experience to all… more
- CVS Health (Salt Lake City, UT)
- …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 submits unemployment claim requests; creates and maintains files for all grievances , State Personnel Board appeals , director's reviews, R6-10, and R5-6 ... notices of R6-10, corrective actions, disciplinary actions, administrative separations, appeals , grievances , 1450-05 reports, termination letters; distribute… 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. Qualifications 1. A… more
- State of Colorado (Denver, CO)
- …employment laws; progressive discipline; records management; recruitment; responding to grievances , appeals , charges of discrimination; reorganization issues; ... retention; selection and selection appeals ; settlement advice; strategic planning and overall HR guidance...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
- State of Colorado (Canon City, CO)
- …reviews, and completing performance evaluations per CDOC regulations, and resolves complaints/ grievances at the informal level; + Ensures staff compliance with the ... daily monitoring, performance management (planning, reviewing and evaluating), resolving complaints/ grievances at the informal level, responsibility for scheduling and… more
- State of Colorado (Denver, CO)
- …to employee relations and providing analysis of potential risk (legal liability, appeals , grievances ) to the delegated staff authority for employee relations. ... in mediation and resolution of employee disputes, performance appraisals, grievances , and crafting corrective actions. + Advises employees and supervisors… more
- State of Colorado (CO)
- …to minimize misunderstandings that may lead to employee dissatisfaction and grievances . Assists with negotiations and leads negotiations efforts for state entity ... the Labor Relations Unit in areas such as negotiations, grievances , and technical research. A summary of the duties...the official appeal form signed by you or your representative . This form must be completed and delivered to… more
- Justice, Bureau of Prisons/Federal Prison System (Grand Prairie, TX)
- …regulations and applicable labor contract provisions. Experience responding to grievances , unfair labor practice complaints, disciplinary decision appeals , ... to Human Resource Managers and Chief Executive Officers on matters involving grievances , unfair labor practices and the interpretation and application of federal… more
- State of Colorado (Grand Junction, CO)
- …providing coaching and/or developing corrective action plans. + Resolves informal grievances , reviews formal grievances , and resolves customer and employee ... complaints. Collaboration - + Acts as the DLO representative for Region IV to organizations, government entities, and...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Pueblo, CO)
- …employment laws; progressive discipline; records management; recruitment; responding to grievances , appeals , charges of discrimination; reorganization issues; ... retention; selection and selection appeals ; settlement advice; strategic planning and overall HR guidance...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