- Point32Health (TX)
- …here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
- Elevance Health (Columbus, GA)
- **SCA Appeals Representative I** **_Locations:_** _This is a virtual position. The ideal candidate must live within 50 miles of one of our NGS_ **_OR_** ... Medicaid Services to transform federal health programs. The **SCA Appeals Representative I** position is an entry-level...review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical… 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 Signature Advantage Overview Seeking an Account Representative for our Signature Advantage Plan who will...senior care partners within plan service area. The Account Representative will use a consultative sales approach to encourage… more
- Washington Headquarters Services (Alexandria, VA)
- …policy, or procedural changes. Provide expert technical assistance and act as the agency representative in MSPB appeals , and may testify as technical expert in ... MSPB appeals . Manage cases related to adverse and disciplinary actions,...interpretation to identify appropriate courses of action. Analyze the grievance system and recommends changes in policy, processes and… more
- State of Colorado (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
- Humana (Madison, WI)
- …Review Level of Care for iCare members including follow-up consultation with Grievance and Appeals or Enrollment/Eligibility/Fiscal staff. * Provide appropriate ... Duties and Responsibilities: *Coordinate appointments with members or legal representative to complete Annual and Enrollment redetermination of functional… 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
- City and County of San Francisco (San Francisco, CA)
- …the City in state and federal civil litigation (through trial and appeals ) and 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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