- Point32Health (TX)
- …direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible per State and Federal regulations ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
- Henry Ford Health System (Troy, MI)
- …for the prompt and thorough investigation of medical 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 when… more
- Molina Healthcare (WI)
- …Educates providers, members and their family members of Medicare and Medicaid grievance and appeals rights. + Determines member eligibility and utilization ... departments and treating providers to effectuate timely resolution resulting from grievance and appeals decisions made at the plan level or by independent review… more
- Highmark Health (Columbus, OH)
- …of a grievance /appeal; documents, investigates, refers and coordinates grievances and appeals ; initiates a case file for each grievance and appeal; ensures ... Review inquiries to determine if they meet definition of appeal/ grievance . + Request and review all related relevant documentation...+ Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement… more
- Point32Health (Canton, MA)
- …we are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Appeals and Grievance (A&G) Coordinator is responsible, per State and ... + Assign new verbal and written appeals and grievances to Appeals and Grievances Analyst + Process Fast Track Appeals including monitoring of Fast Track… more
- City and County of San Francisco (San Francisco, CA)
- …the City in state and federal civil litigation (through trial and appeals ), in administrative proceedings involving labor and employment matters, and provides ... 30 unions that represent City employees, including collective bargaining, labor grievance arbitrations, and defending unfair labor practice and other administrative… more
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