- Generac Power Systems (Waukesha, WI)
- …energy technology solutions company, we continue to push new boundaries. **Job Summary:** The ** Appeals and Grievances Specialist ** is a critical team player ... under general supervision with some guidance from leadership and higher-level Appeals and Grievances Specialists. **Job Responsibilities:** Case Resolution +… 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 ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II is primarily responsible for the… 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 ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides… more
- UCLA Health (Los Angeles, CA)
- …be responsible for: + Managing the intake and resolution of member and provider appeals and grievances in compliance with CMS (Centers for Medicare & Medicaid ... in healthcare operations, managed care, or Medicare Advantage, specifically in handling appeals and grievances preferred * Experience in interpreting CMS… more
- Robert Half Accountemps (Long Beach, CA)
- Description We are seeking an experienced Medical Grievances and Appeals Specialist to join our dynamic team. The successful candidate will be responsible ... for managing all grievances , appeals and complaint processes related to medical services. You will also play an instrumental role in ensuring consistent… more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... purpose. Job Summary The Lead of Customer Solution Center Appeals and Grievances is responsible for assisting...satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring… more
- 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 a ... as well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances , appeals and external reviews for VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Fully ... or appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers....Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents arguments in… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances , appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare ... each grievance or appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... and resolution of cases; review, research and coordination of complaints, grievances , appeals and reconsiderations consistent with statutory and federal… more
- CDPHP (Albany, NY)
- …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 ... Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations… more
- Elevance Health (Meridian, ID)
- …& Appeals Coordinator** is responsible for investigating and reviewing customer grievances and appeals regarding provision of service and benefit coverage ... issues. Triages clinical and non-clinical inquiries, grievances and appeals , prepares case files for...+ Summarizes and presents essential information for the clinical specialist or medical/dental director and legal counsel. + Responds… 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. ... DNR EDO Employee and Labor Relations Specialist II Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4715148) Apply DNR EDO Employee and Labor… more
- Molina Healthcare (Madison, WI)
- …Work with interdepartmental stakeholders to find workable solutions. + Coordinate local appeals , grievances , and State Fair Hearings. This includes member/care ... **Job Description** **Job Summary** The Specialist , Member Rights serves as a member advocate...with interdisciplinary teams (IDTs). Maintains and manages an accessible appeals and grievance system for members to utilize. **Essential… more
- Veterans Affairs, Veterans Health Administration (IN)
- …VA Handbooks and Directives. Responds to inquiries about disciplinary actions, grievances , and appeals concerning timeliness, documentation, and other ... Summary This position serves as a VISN 20 Supervisory Human Resources Specialist - Employee Relations/Labor Relations (ER/LR) located in the Veterans Integrated… more
- LA Care Health Plan (Los Angeles, CA)
- …Center Compliance Audit Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: ... call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This… more
- Indian Health Service (Shiprock, NM)
- …functions: (a) adverse and disciplinary actions, (b) both administrative and union grievances and appeals , (c) employee benefits including retirement, and (d) ... AZ; 1 for Shiprock, NM. The incumbent serves as a Human Resources Specialist in the field of Employee Relations and Labor Relations which specifically includes… more
- Maryland Department of Transportation (Baltimore City County, MD)
- …and local Employment laws, advising and representing management on employee disciplinary appeals and grievances , as well as experience interacting with ... Labor Relations Specialist (Administrator III) Salary $69,323.00 - $112,044.00 Annually...of experience advising and representing management on employee disciplinary appeals and grievances , as well as experience… more
- Henry Ford Health System (Grand Blanc, MI)
- …bargaining agreement negotiations, mediation, and arbitration. + Experience in handling grievances / appeals required and prior involvement in arbitration. + Prior ... facilities and locations as needed. As a strategic partner, the Labor Relations Specialist provides HR and Labor Relations support to leaders and associates within… more