- Generac Power Systems (Waukesha, WI)
- …energy technology solutions company, we continue to push new boundaries. **Job Summary:** The ** Appeals and Grievances Specialist ** is a critical team player ... under general supervision with some guidance from leadership and higher-level Appeals and Grievances Specialists. **Job Responsibilities:** Case Resolution +… more
- Molina Healthcare (GA)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. +… 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 ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- UCLA Health (Los Angeles, CA)
- …be responsible for: + Managing the intake and resolution of member and provider appeals and grievances in compliance with CMS (Centers for Medicare & Medicaid ... in healthcare operations, managed care, or Medicare Advantage, specifically in handling appeals and grievances preferred * Experience in interpreting CMS… 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, ... purpose. Job Summary The Lead of Customer Solution Center Appeals and Grievances is responsible for assisting...satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** Appeals and Grievances Representative supports the Operations Department and the Appeals and Grievances team in a ... as well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances , appeals and external reviews for VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Fully ... or appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers....Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents arguments in… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances , appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare ... each grievance or appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …will consider collective experience, training and education. . 5 years as an Appeals Specialist or equivalent experience in Medicare health insurance claims, ... requests and electronic inquiries in order to identify and classify appeals and grievances as outlined in policies and procedures. Using internal systems,… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** Hybrid position - Temple, TX The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider ... and resolution of cases; review, research and coordination of complaints, grievances , appeals and reconsiderations consistent with statutory and federal… more
- CDPHP (Albany, NY)
- …values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and grievance ... Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations… more
- National Gallery of Art (Washington, DC)
- …and procedural requirements for responding to proposals and for filing complaints, grievances , and appeals . Draft, finalize, and process medical letters, adverse ... in employee and labor relations policies and procedures in such areas as grievances , disciplinary actions, appeals , and performance management for the National… more
- LA Care Health Plan (Los Angeles, CA)
- …Center Compliance Audit Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: ... call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This… more
- Indian Health Service (Shiprock, NM)
- …functions: (a) adverse and disciplinary actions, (b) both administrative and union grievances and appeals , (c) employee benefits including retirement, and (d) ... AZ; 1 for Shiprock, NM. The incumbent serves as a Human Resources Specialist in the field of Employee Relations and Labor Relations which specifically includes… more
- Maryland Department of Transportation (Baltimore City County, MD)
- …and local Employment laws, advising and representing management on employee disciplinary appeals and grievances , as well as experience interacting with ... Labor Relations Specialist (Administrator III) Salary $69,323.00 - $112,044.00 Annually...of experience advising and representing management on employee disciplinary appeals and grievances , as well as experience… more
- Henry Ford Health System (Grand Blanc, MI)
- …bargaining agreement negotiations, mediation, and arbitration. + Experience in handling grievances / appeals required and prior involvement in arbitration. + Prior ... facilities and locations as needed. As a strategic partner, the Labor Relations Specialist provides HR and Labor Relations support to leaders and associates within… more
- US Marine Corps (Arlington, VA)
- …on disciplinary and adverse action notices, performance-based problem notices, processing grievances and appeals ; dealing with complex and sensitive conduct ... Summary You will serve as a Human Resources Specialist (ER/LR) in the Administrative and Resources Division...draft formal correspondence on disciplinary and adverse actions, and appeals . You will represent the Human Resources Branch in… more
- New York State Civil Service (Albany, NY)
- …Homeland Security and Emergency Services, Division of Title Human Resources Specialist 1 Labor Relations/Trainee 1/Trainee 2 (NY HELPS) Occupational Category Other ... the appropriate level** based on their experience and education.**Human Resources Specialist 1 Labor Relations level requirements:*Human Resources Specialist … more
- New York State Civil Service (Albany, NY)
- …Homeland Security and Emergency Services, Division of Title Human Resources Specialist 3 Labor Relations Occupational Category Other Professional Careers Salary ... agency.*Strong public speaking and presentation skills. Duties Description The Human Resources Specialist 3 Labor Relations (HR Spec 3 LR) will report directly to… more
- Naval Air Systems Command (San Diego, CA)
- …You will provide assistance in the areas of discipline, adverse actions, grievances , employee counseling and related functions. You will research facts, legal ... support proposed or final actions. You will respond in writing to appeals or prepare documents for hearings. Requirements Conditions of Employment Qualifications… more