- Guardian Life (Frankfort, KY)
- …contact for all assigned DSOs. Respond to provider inquiries, concerns, complaints, appeals and grievances within assigned timeframes. Collaborate across teams ... to Dental Support Organization (DSO) partners. As a Key DSO Dental Account Manager , Dental Support Organizations , you will be responsible for growing the network… more
- Tufts Medicine (Boston, MA)
- …communities healthy, and bring research breakthroughs to life. **Job Overview** The Senior Employee & Labor Relations Specialist serves as a trusted subject matter ... knowledge of healthcare-specific regulations (eg, HIPAA, Joint Commission standards). The senior specialist plays a critical role in shaping a fair, respectful,… more
- New York State Civil Service (Albany, NY)
- …of their legal rights, advises them of complaint filing procedures, assist with appeals / grievances , or refers them to other government or private agencies. * ... NY HELP Yes Agency Attorney General, Office of the Title Senior Consumer Frauds Representative or Consumer Frauds Representative Trainee (NY HELPS) Occupational… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …works closely with CPR's Director and Clinical Lead, Operations Lead, Senior Credentialing Manager / Compliance Consultant, Risk Specialist, Exception Review ... Specialists and Project Manager . This position is eligible for our Resident, Mobile,...subscriber certificates and apply to the investigation of member grievances . + Manage the fair hearing process for cases… more
- Centene Corporation (Columbus, OH)
- …division of financial responsibility interpretation, contract rate and language interpretation, appeals , grievances and eligibility. + Serve as primary point ... groups, and/or ancillary providers within assigned area. + Act as account manager for assigned groups acting as gatekeeper for interactions with other internal… more
- CHS (Clearwater, FL)
- …client trust. * Investigates and participates in formal responses relating to complaints, grievances and appeals received by or applicable to PAS. Participates ... **Overview** **Claims Manager ** **Servicing** **Health Insurance Policies or Benefits** **Summary:**...as transparency in reporting results, trends and issues to Senior Management and clients. * Management of relationships with… more
- LA Care Health Plan (Los Angeles, CA)
- …purpose. Job Summary The Technical Application Manager II reports to the Senior Manager Information Technology IT Solutions Delivery. This role acts as the ... Technical Applications Manager II Job Category: Information Technology Department: IT...of Membership Eligibility and Enrollment, Member Maintenance, PCP assignment, Appeals and Grievances preferred. EDI 5 years… more
- Volunteers of America Los Angeles (Los Angeles, CA)
- …, and complaints, refers complex matters to HR Employee Relations Specialist or Senior Manager of Employee Relations as required + Participates in training ... work with 20+% dedicated time committed to handling employee complaints, grievances , interactive processes, and disciplinary actions. + Familiarity with case… more
- Healthfirst (NY)
- …but not limited to Care Management, Clinical Eligibility, Behavioral Health, and Appeals and Grievances teams to align utilization decisions** + **Partner ... leadership experience in healthcare management including work experience in a mid- senior management role** + **Work experience and deep familiarity of health… more
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