- Sanford Health (Sioux Falls, SD)
- …appeals and grievance resolution. Lead and manage the end-to-end appeals and grievances process for all product lines, ensuring compliance with federal and state ... the intake, review, resolution, and documentation of all appeals, complaints, and grievances to meet regulatory and operational standards. Ensure all cases are… more
- Molina Healthcare (Caldwell, ID)
- …for the comprehensive research and resolution of the appeals, dispute, grievances , and/or complaints from Molina members, providers and related outside agencies ... that internal and/or regulatory timelines are met. Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. Requests… more
- Molina Healthcare (Racine, WI)
- …Job Duties Facilitates comprehensive research and resolution of appeals, disputes, grievances , and/or complaints from Molina members, providers, and related outside ... internal and/or regulatory timelines are met. Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes.… more
- Humana (Raleigh, NC)
- …first Join a team where your expertise truly makes an impact! As a Grievances & Appeals Representative, you'll be a go-to problem solver, turning complex challenges ... skills to make an impact Required Qualifications 1+ years of grievances and/or appeals experience. Data entry experience. Intermediate proficiency with Microsoft… more
- Cognizant (Frankfort, KY)
- Provider Appeals & Grievances Specialist (remote) This is a remote position open to any qualified applicant that lives in the United States. Summary: We are seeking ... Billing and Coding-Medical Insurance Knowledge of Member/Provider Appeals and Grievances , processes, resolutions, compliance TAT Self-resolved troubleshooting ability for… more
- Highmark Health (Natrona Heights, PA)
- …ESSENTIAL RESPONSIBILITIES Effectively triage, investigate, resolve and document complaints and grievances while ensuring adherence to the Patient Bill of Rights, ... regulatory requirements and network policy Patient Complaints, Grievances and Compliments. Analyze complaints and grievances data and report trends and/or… more
- Washington Metropolitan Area Transit Authority (Washington, DC)
- …counseling, directing management on matters that pertain to grievances , arbitration, employee complaint/resolutions, investigations, training, negotiation, including ... including investigations and the administration of disciplinary actions and contract grievances , using extensive knowledge of WMATA?s five (5) collective bargaining… more
- Elevance Health (Cerritos, CA)
- …that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, regulatory ... quality of care issues to include executive and regulatory grievances . How you will make an impact: ? Reviews,...make an impact: ? Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and… more
- UnitedHealth Group (Boston, MA)
- …Join us to start Caring. Connecting. Growing together The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of ... appeals and grievances cases for UnitedHealthcare associated companies. You'll enjoy the...Primary Responsibilities: Perform individual case review for appeals and grievances for various health plan and insurance products, which… more
- UnitedHealth Group (Cypress, CA)
- …Join us to start Caring. Connecting. Growing together . The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of ... appeals and grievances cases for UnitedHealthcare associated companies. You'll enjoy the...accountabilities include Perform individual case review for appeals and grievances for various health plan and insurance products, which… more
- CN (Homewood, IL)
- …the position participates in regular LR activities. Major Responsibilities Input grievances in a grievance management system Utilize the grievance management system ... and work with Labour Relations Managers on action plans to reduce grievances Support Labour Relations Manager by researching employee issues, including collective… more
- Transdev (Readville, MA)
- …Manage the grievance process and provide comprehensive responses to complaints, grievances , and arbitrations that support the Company's decision and comply with ... and regulations for accurate resolution of appeals, complaints, and grievances . Understand legal requirements and governmental reporting regulations affecting HR/LR… more
- ITG Brands (Greensboro, NC)
- …assisting with employee relation issues to manage employee concerns and grievances and to identify and implement appropriate employee action and accountability ... a fair and inclusive process appropriate for employee concerns or grievances including overseeing employee fact-finding and ensuring adherence to ER policies… more
- BAART Programs (Los Angeles, CA)
- …patient and review as clinically indicated. Respond, as needed, to patient grievances and complaints. Develop aftercare and discharge plans. Other related duties as ... determined by supervisor. Qualifications: Registered Counselor in the State of California. Previous experience working with chemically dependent individuals a plus. Must demonstrate a positive, non-judgmental, and accepting attitude toward our patient… more
- CDM Smith (Woodbury, NY)
- …on employee relations matters, managing conflict resolution, disciplinary actions, grievances , and discrimination concerns. Provide policy guidance and seek legal ... counsel when necessary to ensure compliance and mitigate risk. Partner with other HR teams to address organizational challenges, recommending innovative approaches to enhance departmental efficiency and service delivery. Advise managers on performance feedback… more
- Kiewit (Chicago, IL)
- …to ensure smooth workflow and schedule adherence Resolve employee conflicts, grievances , and scheduling difficulties, informing project and corporate management as ... appropriate Ensure project rules, procedures and programs are followed consistently, including those involving safety, attendance, and workplace behavior standards as reflected in Company's non-harassment and nondiscrimination policies Qualifications 5+ years'… more
- Molina Healthcare (Kenosha, WI)
- …software. Targets and recruits additional providers to reduce member access grievances . Engages targeted contracted providers in renegotiation of rates and/or ... language. Assists with cost control strategies that positively impact the Medical Care Ratio (MCR) within each region. Maintains contractual relationships with significant/highly visible providers. Advises Network Provider Contract Coordinators and Specialists… more
- Transdev (Oakland, CA)
- …Labor Relations issues and work effectively with union partners, including labor grievances and negotiations. Subject to DOT drug testing and physical if applicable. ... DOT Regulation 49 CFR Part 40 does not authorize the use of Schedule I drugs, including cannabis, for any reason. Physical Requirements Must be able to work shifts or flexible work schedules as needed. The employee is generally subjected to long periods spent… more
- Home Depot (White Plains, NY)
- …teams Ability to negotiate, handle complaints, settle disputes, and resolve grievances with both internal and external customers 4 years account management/sales ... management experience 4 plus years home improvement or home building industry experience Successful professional growth in a high paced retail environment Minimum Education: The knowledge, skills and abilities typically acquired through the completion of a… more
- Allied Universal (Long Island City, NY)
- …developing them in both technical and professional skills Assure that employee grievances are heard with help from appropriate district or region HR support ... employees and Account or Operations Manager Administer JSA's and safety programs outlining site-specific hazards for professional security officers on assigned shift including vehicle/driving safety as appropriate to Corporate procedures Assist Account or… more
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