- CVS Health (Baton Rouge, LA)
- …from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance . Responsible for day-to-day implementation of ... case load including but not limited to: -Research incoming electronic appeals , complaints and grievance to identify if appropriate for unit based upon published… more
- Centene Corporation (Indianapolis, IN)
- …High school diploma or equivalent. Associate 's degree preferred. 2+ years grievance or appeals , claims, related managed care experience, or relevant ... benefits including a fresh perspective on workplace flexibility. **Indiana Medicaid and Managed Care** **Must be authorized to work...and appeals + Maintain files on individual appeals and grievances + May coordinate the Grievance… 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...+ Conduct the primary investigation and resolution of member appeals and grievances following established guidelines from: The Center… more
- CareFirst (Baltimore, MD)
- …The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and determination of next steps for Government ... II and III with unit projects and other duties related to the appeals , grievance , and/or reconsideration process. Communicates with Supervisor to offer feedback… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- LA Care Health Plan (Los Angeles, CA)
- …RN is responsible for assisting with the development of a successful and cohesive Appeals and Grievance (A&G) clinical unit. This position is responsible for the ... Lead Customer Solution Center Appeals and Grievances RN Job Category: Clinical Department:...as required. Perform other duties as assigned. Education Required Associate 's Degree in Nursing for Registered Nurses Education Preferred… more
- Humana (Baton Rouge, LA)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational… more
- Humana (Indianapolis, IN)
- …not be limited to, an overview of coding practices and clinical documentation, grievance and appeals processes (including pharmacy), and reviews for DME, genetic ... and other reference sources. Medical Directors will learn North Central region state Medicaid requirements (currently VA, KY, OH, IN, WI) and will understand how to… more
- Humana (Raleigh, NC)
- …roles include an overview of coding practices and clinical documentation, dispute, grievance , and appeals processes, and outpatient services and equipment, ... of business, member population, or condition type. May also engage in dispute, grievance , and appeals reviews. May participate on project teams or organizational… more
- Humana (Carson City, NV)
- …Some roles include an overview of coding practices and clinical documentation, dispute/ grievance and appeals processes, and outpatient services and equipment, ... and other reference sources. Medical Directors will learn Medicare, Medicaid , and Medicare Advantage requirements and will understand how...and care received. May also engage in disputes and grievance and appeals reviews. May participate on… more
- LA Care Health Plan (Los Angeles, CA)
- …Required: At least 2 years of experience resolving health care eligibility, access, grievance and appeals issues, preferably in health services, legal services ... and Plan Partners: Department of Health Services (DHS), Centers for Medicare and Medicaid Services (CMS) National Committee Quality Assurance (NCQA) as well as LA… more
- Humana (Louisville, KY)
- …+ Do you currently reside in the state of Kentucky. + Experience in Grievance and Appeals . + CRM experience **Additional Information** As part of our ... (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart… more
- BrightSpring Health Services (Bowling Green, KY)
- …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 ... and marketing presentations in accordance with applicable Centers for Medicare & Medicaid Services (CMS) and State guidelines and standards. + Conduct individual… more