- 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, ... support the safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse… more
- 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, ... to support the safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II is primarily… 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 ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G)...provide resolution of complaints in compliance with Centers for Medicare and Medicaid Services (CMS), California Department of Health… more
- Apex Health Solutions (Houston, TX)
- …coordinator position is focused on the processing of customer and provider Medicare and Commercial appeals and grievances . This associate may screen incoming ... of insurance inquiries. The position will promote quality patient care and customer service /satisfaction, while promoting safety, cost efficiency and a… more
- Apex Health Solutions (Houston, TX)
- …Senior position, is focused on the processing of customer and provider Medicare and Commercial appeals and grievances . This associate may screen incoming ... of insurance inquiries. The position will promote quality patient care and customer service /satisfaction, while promoting safety, cost efficiency and a… more
- Health First (Rockledge, FL)
- …* o Highly advanced verbal and written communication skills. o Effective customer service techniques. o Analytic and creative problem-solving skills. o ... fully engaged in providing Uncompromised Safety, Superior Quality, Memorable Patient/ Customer Experiences, and Financial Stewardship by resolving member complaints… more
- Medical Mutual of Ohio (OH)
- …or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals, Grievances , and Medicare marketing material requirements. . Assists in ... or updated CMS regulations, Coverage Gap Discount, Coverage Determinations and Appeals, Grievances , and Medicare marketing material requirements. . Assists in… more
- Point32Health (Canton, MA)
- …health and wellbeing easier. We enjoy the important work we do every day in service to our members, partners, colleagues and communities. To learn more about who we ... decisions. The Senior Manager will also lead and support the annual new contract/ service area application process with CMS. Once new product designs are approved by… more
- Blue Cross and Blue Shield of Louisiana (Monroe, LA)
- …+ Experience in corporate office setting preferred **Skills and Abilities** + Customer service -driven with excellent phone etiquette + Proficient in Microsoft ... is preferred for all positions. **Grade 02** **POSITION PURPOSE** The Medicare Member Retention Representative is responsible for identifying potential problems or… more
- VNS Health (Manhattan, NY)
- …processes and procedures for improved department operations and customer service . + Reviews information available from Medicaid, Medicare , other payers, ... and federal regulatory requirements related to all aspects of grievances and appeals for Medicare managed care...all aspects of grievances and appeals for Medicare managed care organizations, Medicaid, home health care, managed… more
- VNS Health (Manhattan, NY)
- …processes and procedures for improved department operations and customer service . + Reviews information available from Medicaid, Medicare , other payers, ... and federal regulatory requirements related to all aspects of grievances and appeals for Medicare managed care...all aspects of grievances and appeals for Medicare managed care organizations, Medicaid, home health care, managed… more
- LA Care Health Plan (Los Angeles, CA)
- …Customer Solution Center Compliance Audit Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... support the safety net required to achieve that purpose. Job Summary The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the… more
- US Tech Solutions (Orange, CA)
- …related to grievances and appeals. Monitors incoming complaints via the Customer Service system routing, interdepartmental referral, mail, telephone, fax or ... in a mission-driven culture of high-quality performance, with a member focus on customer service , consistency, dignity and accountability. Assists the team in… more
- Sharp HealthCare (San Diego, CA)
- …information in a manner that facilitate maximum financial reimbursement and promotes premier customer service . This role utilizes Patient Secure to identify the ... at all times.Negotiates with others, handles minor complaints by settling disputes, grievances , and conflicts.Perform service recovery when The Sharp Experience… more
- Banner Health (Tucson, AZ)
- …work in a fast-paced, sometimes stressful environment with a strong focus on customer service . Interacts with staff at all levels throughout the organization. ... **Primary City/State:** Arizona, Arizona **Department Name:** Grievances & Appeals **Work Shift:** Day **Job Category:**...(BPN) is a nationally recognized healthcare leader that integrates Medicare and private health plans. Our main goal is… more
- Arab Community Center for Economic and Social Serv (Dearborn, MI)
- Intake & Customer Service Specialist Department: Community Health & Research Center Location: Dearborn, MI START YOUR APPLICATION ... (https://apply.hrmdirect.com/resumedirect/ApplyOnline/Apply.aspx?req\_id=2891944&source=2891944-CJB-0) Job Title: Intake and Customer Service Specialist Job Status: Full-time Job… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …and education. . 5 years as an Appeals Specialist or equivalent experience in Medicare health insurance claims, customer service , billing or related ... inquiries in order to identify and classify appeals and grievances as outlined in policies and procedures. Using internal...and Knowledge:** . Strong knowledge of claims operations and customer service policies, procedures and systems. .… more
- University of Washington (Seattle, WA)
- …+ An understanding of behavioral health care regulations. + Experience-based knowledge of customer service techniques. + Proven ability to work effectively in a ... compliance with respect to the management of adverse patient events and patient grievances . The Senior Clinical Risk Manager will be the lead for managing risks… more
- Humana (San Juan, PR)
- …transactions or interactions and acting accordingly. + Escalating unresolved and pending customer service grievances . + Performing other relevant duties ... are fluent in English and Spanish and enjoy providing customer service over the phone, this could...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel,… more
- CVS Health (Phoenix, AZ)
- …(CMS). **Required Qualifications** - 2 plus years of experience working within a customer service role on several computer applications and complex databases for ... CVS Health has an exciting new opportunity within the Grievances team in Scottsdale, AZ. As a Grievance Analyst,...members have about their coverage and benefits provided through Medicare Part D. You will have the opportunity to… more