- Henry Ford Health System (Troy, MI)
- …the prompt and thorough investigation of medical and pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): Commercial, Medicare ... AND RESPONSIBILITIES: + Conduct the primary investigation and resolution of member appeals and grievances following established guidelines from: The Center for… more
- City and County of San Francisco (San Francisco, CA)
- …City and County of San Francisco is looking to bring on board multiple Senior Human Resources Analysts to help departments in hiring, supporting, and retaining a ... growth, the City offers excellent benefits that include: competitive salaries; medical , dental, and vision insurance; defined benefit retirement plan; deferred… more
- Tufts Medicine (Boston, MA)
- …to deliver exceptional, connected, and accessible care. Our system includes Tufts Medical Center, the principal teaching hospital of Tufts University and Tufts ... communities healthy, and bring research breakthroughs to life. **Job Overview** The Senior Employee & Labor Relations Specialist serves as a trusted subject matter… more
- State of Colorado (Denver, CO)
- Senior Staff Accountant Supervisor Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5164739) Apply Senior Staff Accountant Supervisor ... holidays per year plus vacation and sick leave * Medical , dental, and vision plans * State paid life...hire. + Resolve problems, performance issues, disputes, and informal grievances and initiate corrective action or recommend discipline as… more
- New York State Civil Service (Albany, NY)
- …of their legal rights, advises them of complaint filing procedures, assist with appeals / grievances , or refers them to other government or private agencies. * ... NY HELP Yes Agency Attorney General, Office of the Title Senior Consumer Frauds Representative or Consumer Frauds Representative Trainee (NY HELPS) Occupational… more
- CGI Technologies and Solutions, Inc. (Canton, MA)
- …such as: o Claims processing o Provider data management o Auth/UM/CM workflows o Appeals & grievances o Enrollment & billing o Member services o Network ... ** Senior Payer Process Assessment & BPM Lead** **Category:**...religion, creed, age, national origin, citizenship status, disability, pregnancy, medical condition, military and veteran status, marital status, sexual… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …membership + Healthcare Contracting and Management Team + Legal Department: + Medical Directors + Member Appeals Grievance Programs (Commercial, Medicare ... closely with CPR's Director and Clinical Lead, Operations Lead, Senior Credentialing Manager/ Compliance Consultant, Risk Specialist, Exception Review Specialists… more
- The Cigna Group (Salem, OR)
- …Complete onsite quality assessments + Respond to provider inquiries, concerns, complaints, appeals and grievances + Provide ongoing product education to dentists ... one of your employment, you'll be offered several health-related benefits including medical , vision, dental, and well-being and behavioral health programs. We also… more
- CVS Health (Tallahassee, FL)
- … director teams focusing on inpatient care management, clinical coverage review, member appeals clinical review, medical claim review, and provider appeals ... as needed. * Outward facing position to interact and collaborate with medical / physical professional associates, the local provider community, state regulatory… more
- UPMC (Pittsburgh, PA)
- …improvement review processes, including concurrent, prospective and retrospective reviews, member grievances , provider appeals , and potential quality of care ... latest trends in field of expertise. + Mentorship commitment from Chief Medical Officers and senior leaders Licensure, Certifications, and Clearances:Doctor of… more
- State of Colorado (Pueblo, CO)
- …safe, secure, and therapeutic setting for patients with both psychiatric and medical issues. The services provided include evaluation and treatment for patients who ... are completed and in compliance with CMHHIP policies and psychiatric and medical nursing standards, licensure requirements and governing bodies. + Unit nursing staff… more
- City of New York (New York, NY)
- …and administer the contractual grievance process. Serve as Hearing Officer for grievances and disciplinary appeals . Represent the agency at hearings before ... play a key role in managing internal labor relations investigations, union grievances , and collective bargaining agreements and engagement with Union Partners, and… more
- Volunteers of America Los Angeles (Los Angeles, CA)
- …and resolution of facts and issues in matters affecting disciplinary actions, grievances , appeals , and complaints, refers complex matters to HR Employee ... PAY RATE:$74,014.50 - $77,910 Per Year BENEFITS:VOALA offers competitive medical , dental, vision and retirement benefits. JOB SUMMARY AND...Relations Specialist or Senior Manager of Employee Relations as required + Participates… more
- University of Colorado (Aurora, CO)
- …faculty affairs efforts on campus & community committees as directed by the Senior Associate Dean for Faculty. + Oversee the Office for Faculty Affairs including ... and university leadership. + Address faculty concerns regarding grievance procedures, and appeals processes and serve as a neutral party and advisor in faculty… more
- CHS (Clearwater, FL)
- …client trust. * Investigates and participates in formal responses relating to complaints, grievances and appeals received by or applicable to PAS. Participates ... service, claims administration, is where submissions for payment/reimbursement/sharing from medical providers and covered individuals are reviewed, subject to cost… more
- City of Jacksonville (Jacksonville, FL)
- …Description This is a Labor and Employment Attorney position that reports to a senior attorney. The primary purpose of this position is to provide labor and ... assigned clients. Work is performed under the direction of a managing or senior attorney and is reviewed through conferences, inspection of work product and… more
- MTA (New York, NY)
- …involving labor relations issues such as contract interpretation, disciplinary matters , medical appeals , Civil Service Law, and matters affecting Authority-wide ... Civil Service Law, matters affecting authority-wide policy and procedures, and involuntary medical leave. + Handles complex contractual grievances that may have… more
- LA Care Health Plan (Los Angeles, CA)
- …Functional knowledge of Membership Eligibility and Enrollment, Member Maintenance, PCP assignment, Appeals and Grievances preferred. EDI 5 years of EDI Domain ... Summary The Technical Application Manager II reports to the Senior Manager Information Technology IT Solutions Delivery. This role...Off (PTO) + Tuition Reimbursement + Retirement Plans + Medical , Dental and Vision + Wellness Program + Volunteer… more
- Guardian Life (Phoenix, AZ)
- …contact for all assigned DSOs. Respond to provider inquiries, concerns, complaints, appeals and grievances within assigned timeframes. Collaborate across teams ... manage contracts and financial reimbursement rates with DSOs + Make presentations to senior -level management of DSOs + Identify and report to leadership team on… more