- Humana (Indianapolis, IN)
- …of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties… more
- Conduent (Hamilton, NJ)
- …a culture where individuality is noticed and valued every day. Fair Hearing Appeals Agent $18.50/ Hourly Onsite- Hamilton, NJ Full-time and Full Benefits **Location ... Summary** An experienced healthcare (Medicaid & CHIP) call-center based customer service representative to process requests for an appeal (Fair Hearings for Plan A… more
- Independent Health (Buffalo, NY)
- …ICD-9-CM, ICD-10-CM and HCPCS coding preferred. + Experience in Compliance regulations, appeals and grievance knowledge preferred. + Demonstrated ability to ... and commitment to diversity and inclusion. **Overview** The Provider Relations Representative is responsible for assisting our provider constituents and providing… more
- Insight Global (Norfolk, VA)
- …claim types and statuses. Review claims details with members and assist with EOB inquiries. Grievance and Appeals Initiate grievance and appeals requests ... Job Description We are seeking a dedicated Healthcare Customer Service Representative to join our team. This role involves assisting members with inquiries related… more
- CDS Life Transitions (Webster, NY)
- …at least one of the following areas: call center operations, MLTC, grievance and appeals , and/or authorizations. Physical Requirements/Working Conditions: + Must ... benefits, please apply to find out more! Summary: A Member Services Representative is responsible for providing iCircle members with exceptional customer service. A… more
- Highmark Health (Dover, DE)
- …This position is also responsible for assisting members in navigating the grievance and appeals process and representing member interests internally and ... Service **Preferred** + Familiarity as a Member Advocate or with complaint and grievance processes + Familiarity with Delaware Medicaid and the Medicaid LTSS benefit… more
- BrightSpring Health Services (Chattanooga, TN)
- …to Member and Provider issues. Refer all unresolved issues to the next level including grievance and appeals . + Actively market plan to new senior care partners ... Our Company Abode Care Partners Overview Seeking an Account Representative for our Signature Advantage Plan who will work with senior care partners to assist in… more
- CVS Health (Austin, TX)
- …+ Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system . + ... Educates & assists providers on our self-service options. Assists providers with credentialing and re-credentialing and contracting questions and issues. + Assists in compiling claim data for customer audits. Determines medical necessity, applicable coverage… more
- Maryland Department of Transportation (Anne Arundel County, MD)
- …the delegated representative of the Secretary of Transportation for Second Step grievance appeals and disciplinary action appeals . + Negotiating the ... limited to: collective bargaining activities including negotiations, labor-management meetings, grievance handling, training and/or dispute resolution matters. Core competencies:… more
- State of Colorado (CO)
- …grammar, spelling, punctuation and formatting; + Provide initial guidance/review of Grievance and 1450-05 complaint responses; assist with grievance panels; ... Personnel Board Rules, legal precedence, and DOC performance standards. Appeals & Legal Case- Requests for Information + Exercise...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
- Sacramento Municipal Utility District (Sacramento, CA)
- …defensible reports and disciplinary documents + Experience responding to grievances or appeals and serving as an employer representative in administrative ... one or more collective bargaining units, including day-to-day contract management, grievance response and resolution, and labor negotiations. This position may also… more
- State of Colorado (Denver, CO)
- …Coloradans can easily navigate and access needed services, including collaboration with the Grievance Section of the BHA to problem-solve and improve these areas of ... the official appeal form, signed by you or your representative . This form must be delivered to the State...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Government Accountability Office (Washington, DC)
- …of GAO's labor-management relations program, and serving as management's legal representative in grievance proceedings under the negotiated grievance ... the following: Managing a docket of administrative litigation before the GAO Personnel Appeals Board (PAB) covering a wide range of personnel and labor matters (eg,… more
- State of Colorado (Golden, CO)
- …team meetings in collaboration with CYSO III + Ensure that youth grievance policy and procedure are followed. Review of grievances to include investigation, ... the official appeal form, signed by you or your representative . This form must be delivered to the State...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Denver, CO)
- …referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance with DOC Administrative ... the official appeal form, signed by you or your representative . This form must be delivered to the State...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Roper St. Francis (SC)
- …resolutions, receives & forwards compliments, issues acknowledgement letters, forwards grievance forms within the designated timeframe, assists with accreditation ... or healthcare preferred. Prior experience working with grievances and appeals strongly preferred. Knowledge of RSFH organizational structure strongly preferred.… more
- LA Care Health Plan (Los Angeles, CA)
- …Oversee overtime work and will produce accurate accounting of each representative work performance. Conducting evaluations of and implementing enhancements to the ... inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance /appeal requests, and prepares UM Activity and Weekly Compliance… more
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