- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II is primarily responsible for the overall coordination… more
- UCLA Health (Los Angeles, CA)
- Description As the Appeals and Grievances (A&G) Analyst, you will be responsible for assisting with all operational aspects of appeals and grievances , in ... to the time constraints imposed by CMS on Medicare appeals and grievances . + Collaborates closely with beneficiaries, healthcare providers, and insurance companies… more
- UCLA Health (Los Angeles, CA)
- Description As the Senior Appeals and Grievances Analyst, you will be responsible for: + Assisting with all operational aspects of appeals and grievances , in ... regulations. + Assisting the unit Supervisor in overseeing the appeals and grievances process, ensuring that members and providers receive fair and accurate… more
- UCLA Health (Los Angeles, CA)
- Description As the Appeals and Grievances (A&G) Analyst, you will be responsible for assisting with all operational aspects of appeals and grievances , in ... to the time constraints imposed by CMS on Medicare appeals and grievances . + Collaborates closely with beneficiaries, healthcare providers, and insurance companies… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides direct assistance to… more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... that purpose. Job Summary The Lead of Customer Solution Center Appeals and Grievances is responsible for assisting with the development of a successful and cohesive… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for executing the day-to-day clinical… more
- Apex Health Solutions (Houston, TX)
- Summary: The Appeals and Grievances coordinator position is focused on the processing of customer and provider Medicare and Commercial appeals and grievances . ... and Appeals Tracking. Coordination of Appeals, Adverse Determinations and Grievances . Corresponds with members, providers and regulators regarding decisions and… more
- Apex Health Solutions (Houston, TX)
- Summary: The Appeals and Grievances coordinator, Senior position, is focused on the processing of customer and provider Medicare and Commercial appeals and ... grievances . This associate may screen incoming complaints, process medical...and Appeals Tracking Coordination of Appeals, Adverse Determinations and Grievances Corresponds with members, providers and regulators regarding decisions… more
- Elevance Health (Walnut Creek, CA)
- …The **Manager II Grievance/Appeals** is responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to ... grievances and appeals, manages inventory and production levels, and...decisions, pharmacy on pre-service and post service appeals and grievances related to non-clinical and clinical services, quality of… more
- Humana (Indianapolis, IN)
- …a part of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a ... and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider… more
- Health First (Melbourne, FL)
- …resolve internal operational issues that may cause increase to member appeals/ grievances volumes and drive operational efficiencies. 10. Maintain technical knowledge ... Insurance)* **Organization:** **HF Administrative Plan Inc* **Title:** *Manager Complaints, Grievances , and Appeals* **Location:** *Florida - Brevard County-Melbourne* **Requisition… more
- Generac Power Systems (Waukesha, WI)
- …we continue to push new boundaries. **Job Description:** The **Appeals and Grievances Coordinator** is a critical team player who is responsible for providing ... supervision with some guidance from leadership and higher-level Appeals and Grievances Specialists. **Job Responsibilities:** + Perform a variety of duties… more
- Healthfirst (AZ)
- …position is Remote + Conduct quality audits of A&G items including grievances , pre-service appeals, and post service appeals utilizing appropriate sources of ... and performance to ensure quality. + Review and investigate appeals and grievances requests to ensure all requests are identified, classified, and fully resolved… more
- Generac Power Systems (Waukesha, WI)
- …company, we continue to push new boundaries. **Job Summary:** The **Appeals and Grievances Specialist** is a critical team player who is responsible for providing ... with some guidance from leadership and higher-level Appeals and Grievances Specialists. **Job Responsibilities:** Case Resolution + Handles escalated calls/cases… more
- Health First (Rockledge, FL)
- …Plan Inc* **Title:** *HFHP Appeal /Grievance Coordinator - Member Appeals Grievances * **Location:** *Florida - Brevard County-Rockledge* **Requisition ID:** *075564* ... Success in this position will be based on the individual's ability to effectively research, document, analyze and resolve complaints according to complex and strict rules, while identifying and communicating issues appropriately. *PRIMARY ACCOUNTABILITIES:*… more
- Humana (Columbus, OH)
- …+ MD or DO degree + A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of ... assignment + Board Certified in an approved ABMS Medical Specialty + Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Possess analysis… more
- VNS Health (Manhattan, NY)
- …to: * Lead with Purpose: Manage day-to-day activities for staff handling grievances and appeals across our Managed Long Term Care (MLTC), Medicare Advantage ... meet our high standards for operational and regulatory compliance in managing grievances and appeals on our behalf. * Data-Driven Decisions: Maintain the integrity… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA-Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances team ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally,...member outreach as well as supports the Appeal and Grievances team in creation, review and mailing of member… more
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