- VNS Health (Manhattan, NY)
- …Utilization ReviewDiscipline: RNStart Date: ASAPDuration: OngoingEmployment Type: StaffResolves grievances , appeals and external reviews for one ... each grievance or appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with… more
- Health First (Rockledge, FL)
- …Administrative Plan Inc* **Title:** *Business Ops Analyst HFHP - Member Appeals Grievances * **Location:** *Florida - Brevard County-Rockledge* **Requisition ... Apply descriptive statistical data to business operations and present recommendations to leadership in a meaningful format. Consult with the business client to understand, define and provide information to inform the problem and recommend solutions. Work… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, ... achieve that purpose. Job Summary The Supervisor, Customer Solution Center Appeals and Grievances is responsible for direct supervision and support of the team… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct… 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, ... to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and… more
- Generac Power Systems (Waukesha, WI)
- …into an energy technology solutions company, we continue to push new boundaries. The ** Appeals and Grievances Specialist** is a critical team player who is ... under general supervision with some guidance from leadership and higher-level Appeals and Grievances Specialists. **Job Responsibilities:** Case Resolution +… more
- Insight Global (Los Angeles, CA)
- Job Description The Supervisor of the Customer Solution Center Appeals and Grievances is responsible for directly supervising and supporting the team that ... handles the intake, research, resolution, tracking, trending, and reporting within the Appeals and Grievances department. This role involves leading and… more
- Insight Global (Los Angeles, CA)
- Job Description The Customer Solution Center Appeals and Grievances Specialist I will support the Appeals and Grievances team to receive, investigate and ... -Primary function of this role is to learn the specialty level appeals and grievances work by resolving less complex cases to ensure positive outcomes for… more
- Humana (Columbus, OH)
- …a part of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting ... and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer… more
- G-TECH Services, Inc. (Detroit, MI)
- …Grievance and Appeals (G&A) Coordinator is responsible for processing appeals , grievances , complaints, and inquiries received from members, authorized ... to resolve the customer's concerns. The outcome and resolution of all appeals , grievances , complaints, and inquiries is communicated via written correspondence… more
- CDPHP (Albany, NY)
- …This individual will be responsible for tracking, trending and monitoring of appeals , grievances , NYS external review, and making recommendations for change. ... 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… more
- CDPHP (Albany, NY)
- … Appeals Coordinator is responsible for the timely and accurate triaging all appeals , grievances , and complaints that come in to the department, and working ... information to process their requests within regulatory guidelines. The Appeals Coordinator is also responsible for daily/weekly/monthly department reporting, and… more
- TEKsystems (Los Angeles, CA)
- …+ Gather analyze and report verbal and written member and provider complaints grievances and appeals + Prepare response letters for member and provider ... complaints grievances and appeals + Maintain files on individual appeals and grievances + May coordinate the Grievance and Appeals Committee +… more
- Henry Ford Health System (Troy, MI)
- …the prompt and thorough investigation of medical, transportation, and pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): Commercial, ... AND RESPONSIBILITIES:\ + Conduct the primary investigation and resolution of member appeals and grievances following established guidelines from: The Center for… more
- Baylor Scott & White Health (Temple, TX)
- …and resolution of cases; review, research and coordination of complaints, grievances , appeals and reconsiderations consistent with statutory and federal ... OF THE ROLE** + Maintains data entry requirements for all complaints, appeals and grievances . + Builds case files for each complaint, appeal and grievance, and… more
- Humana (Columbus, OH)
- …Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director reviews cases of diverse scope and complexity ... PHI / HIPAA information This is a remote position reporting to Grievance and Appeals Director or MD Team Lead **Scheduled Weekly Hours** 40 **Pay Range** The… more
- G-TECH Services, Inc. (Detroit, MI)
- Process appeals and grievances , analyze, research, and provide comprehensive responses in accordance with established regulatory and accreditation guidelines. ... Skills/Experience - Optional but preferred skills/experience. Include: * Grievance and Appeals experience. * Degree in Healthcare * Experience in analyzing a… more
- Elevance Health (Indianapolis, IN)
- …that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, ... you will make an impact:** + Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory… more
- Centene Corporation (Raleigh, NC)
- …or equivalent experience. Master's Degree preferred. 5+ years of experience in grievances , appeals , or healthcare law related fields. Previous management ... our Raleigh office. **Position Purpose:** Responsible for oversight of member appeals and grievance processes. Directs and ensures the efficient operational… more
- Elevance Health (Topeka, KS)
- …Capabilities and Experiences:** + Experience with Claims, Provider Payments, Provider Grievances , Appeals , administrative hearings, or other legal processes + ... **Provider Grievance and Appeals - Business Change Advisor** **Location: Topeka KS, or...Kansas Elevance Health PulsePoint locations. The **Provider Grievance and Appeals - Business Change Advisor** is responsible for representing the… more
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