- Elevance Health (Richmond, VA)
- **Title: Grievance / Appeals Analyst II** **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 II** will be responsible for reviewing, analyzing and processing non-complex and some… 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… more
- Henry Ford Health System (Troy, MI)
- …prompt and thorough investigation of medical, transportation, and pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): Commercial, Medicare ... Advantage, Medicare-Medicaid Program (MMP), and Medicaid lines of business. Analyst must identify trending issues on an ongoing basis and provide root/cause analysis… more
- TEKsystems (Chicago, IL)
- …procedures of Pharmacy Solutions Skills & Qualifications: Insurance Verification Prior Authorization Grievance and Appeals Insurance Analyst High School ... Teksystems is currently seeking experience Insurance Analyst candidates who are comfortable re-working denials. Job...entire documentation and filing process for prior authorizations and appeals . Monitor the status to ensure a rapid turnaround… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeal and Grievance Compliance Advisor Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances ... documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This position is… more
- The Cigna Group (Nashville, TN)
- …with every other weekend (Tuesday ALT Day).** + Must have experience in Medicare Appeals , Utilization Case Management or Compliance in Medicare Part C + Ability to ... differentiate different types of requests Appeals , Grievances, coverage determination and Organization Determinations in order to ensure the correct processing of… more
- City of Lakeland (Lakeland, FL)
- HR Analyst - Policy and Employee/Labor Relations Print (https://www.governmentjobs.com/careers/lakelandfl/jobs/newprint/4429048) Apply HR Analyst - Policy and ... represents the City of Lakeland in unemployment claims and appeals hearings, securing the participation of the HR Director...you have experience in Public Sector collective bargaining and/or grievance handling? + Yes + No 11 Please provide… more
- City and County of San Francisco (San Francisco, CA)
- …and provider relationships. + Oversees the work of the Shelter Grievance Advisory Committee (SGAC), the Shelter Monitoring Committee (SMC), and collaborates ... Rule 111A.35.1. The standard for the review of such appeals is 'abuse of discretion' or 'no rational basis'...online application was not submitted or received. Human Resources Analyst Information: If you have any questions regarding this… more
- CVS Health (Lansing, MI)
- …obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals , SIU, etc. + Coordinates provider status information ... Position Summary + Lead a team of Medicaid Provider Data Services Analyst responsible for loading and maintaining Medicaid Provider data within Aetna QNXT.… more
- CVS Health (Austin, TX)
- …obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals , SIU, etc.- Coordinates provider status information ... hybrid in Texas** - Lead a team of Medicaid Provider Data Services Analyst responsible for loading and maintaining Medicaid Provider data within Aetna QNXT.- Team… more
- LA Care Health Plan (Los Angeles, CA)
- …following 3 health plan functions: Call Center Operations, Enrollment Services Operations, Appeals & Grievance Operations For Advanced Analytics Lab: Preferred: ... experience requirement. Preferred: Experience in leading a team of data analyst knowledgeable in SQL. Experience and knowledge in Python and/or R… more
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