- Elevance Health (Los Angeles, CA)
- **Title: Grievance / Appeals Analyst 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 Analyst I** is an entry level position in the Enterprise Grievance & Appeals Department that… more
- Elevance Health (Indianapolis, IN)
- **Title: Grievance / Appeals Analyst 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 Analyst I** is an entry level position in the Enterprise Grievance & Appeals Department that… more
- VNS Health (Manhattan, NY)
- …criteria. + Enters data and assists with compiling reports and analysis on the grievance and appeals process. For Fair Hearings: + Supports Grievance ... issues pertaining to State Fair Hearings. Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents arguments in defense of the… more
- Elevance Health (Richmond, VA)
- **Title: Grievance / Appeals Analyst Lead** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of ... a California PulsePoint location. The ** Grievance / Appeals Analyst Lead** will be responsible for...a quality manner. + May also be responsible to provide review and analysis of complex pre service and… more
- Elevance Health (Norfolk, VA)
- ** Grievance / Appeals Analyst Lead** **Candidates must be located within 50 miles of Atlanta, GA, Miami, FL, Mason, OH, Norfolk, VA, Tampa, FL, or Topeka, KS** The ... ** Grievance / Appeals Analyst Lead** is responsible for leading...a quality manner. + May also be responsible to provide review and analysis of complex pre service and… more
- Elevance Health (Atlanta, GA)
- …and plan risk, ensures quality, and regulatory compliance.** PRIMARY DUTIES: + Coordinates Grievance and Appeals Committee Meetings and Member Panel Hearings. + ... Leads grievance and appeals in regulated audits. +...like Power Pivot. + Develops predictive models to forecast business needs and meet key objectives. + Serves as… more
- Elevance Health (Meridian, ID)
- **Title: Grievance & Appeals Coordinator** **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 Coordinator** is responsible for...or any combination of education and experience which would provide an equivalent background. Please be advised that Elevance… 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, analyzing and processing claims in accordance… more
- Baylor Scott & White Health (Temple, TX)
- … Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and grievance cases for products for ... of cases; review, research and coordination of complaints, grievances, appeals and reconsiderations consistent with statutory and federal regulatory guidelines.… more
- Humana (Columbus, OH)
- …**Preferred Qualifications** + Bachelor's Degree - Preferred + More than 3 years of grievance and appeals experience + Strong knowledge in Microsoft Access or ... help us put health first** The Manager, Grievances & Appeals manages client denials and concerns by conducting a...review of clinical documentation to determine if an a grievance , appeal or further request is warranted and then… more
- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, October 7, 2024 Centers Plan for Healthy Living's goal is ... the guidance and plans they need for healthy living. JOB SUMMARY: The Grievance & Appeal Clinical Reviewer performs complex medical necessity reviewed on Initial… more
- Health First (Rockledge, FL)
- …Plans (Health Insurance)* **Organization:** **HF Administrative Plan Inc* **Title:** *HFHP Appeals / Grievance Coordinator - Member Appeals Grievances* ... * Minimum one (1) year of experience with healthcare business office or health plan. * Advanced knowledge of...stressful environment. * Ability to analyze various situations and provide solutions where appropriate. * Ability to handle multiple… more
- CVS Health (Richmond, VA)
- …current policies/guidelines. -Collaborative working relationships. -Thorough knowledge of member and/or provider appeals , complaints and grievance policies. ... from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance . Identify trends and emerging issues and report… more
- CVS Health (Richmond, VA)
- …multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance . Responsible for day-to-day implementation of Aetna's ... initiation of appeal process. -Identify and research all components within member or provider /practitioner appeals , complaints and grievance for all products… more
- LA Care Health Plan (Los Angeles, CA)
- …related to grievances and appeals . Responsible for handling member and provider appeals providing clinical reviews and write-ups and recommendations, mailing ... is primarily responsible for the overall coordination of the Appeals & Grievance (A&G) program for LA...team player, able to work effectively with various internal business units, Plan Partners, participating provider groups,… more
- BayCare Health System (Clearwater, FL)
- …ensuring adherence to regulatory requirements. + Triage, plan, and execute intake of Appeals and Grievance submissions. + Keeping track of deadlines, ensuring ... be working remotely? Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Grievance Specialist-Health Plan **Location** Clearwater:Park Place | Business… more
- Elevance Health (Los Angeles, CA)
- …will make an impact:** + Conducts investigations and reviews of member and provider medical necessity appeals . + Reviews prospective, inpatient, or retrospective ... **Nurse Appeals - Licensed RN Nurse** **Location:** This position...timely to meet regulatory timeframes. + Documents and logs appeal/ grievance information on relevant tracking systems and mainframe systems.… more
- Point32Health (MA)
- …the general direction of the Senior Manager of Appeals and Grievances the Appeals and Grievance Supervisor, through the use of general knowledge of Plan ... coordinate and provide leadership for the daily operations of the Appeals and Grievances department. The Supervisor represents the Appeals and Grievances… 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 ... assistance for medical services may appeal Fair Hearing or Grievance decisions to which they were denied coverage, or...were denied coverage, or their coverage was terminated. Our Appeals Counselors process these appeals from applicants… more
- CareFirst (Baltimore, MD)
- …management decisions themselves and the consequences of those decisions by way of appeals , for all lines of business that result in demonstrable impacts ... of their week at a CareFirst location based on business needs and work activities/deliverables that week. **PURPOSE:** Under...Appeals , Grievances & Clinical Medical Review: Oversees the Appeals and Grievance function as well as… more