- 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 (Columbus, OH)
- …+ 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
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Training Specialist II Job Category: Customer Service Department: CSC Training & Performance Location: Los ... required to achieve that purpose. Job Summary The Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II is primarily responsible for… more
- Healthfirst (NY)
- …+ Bachelors degree + Experience in clinical practice with experience in appeals & grievances , claims processing, utilization review or utilization ... of services. The end to end process requires the Specialist to independently: + Research issues + Quality of...a framework that measures productivity and quality for each Specialist against expectations + Prepare cases for Medical Director… more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances ... 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
- LA Care Health Plan (Los Angeles, CA)
- …due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist .; submit all Grievances and Appeals response letters ... Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the… 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
- 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
- University of Michigan (Ann Arbor, MI)
- Revenue Cycle Coding Supervisor - Appeals & Denials Apply Now **Job Summary** The Denial Coding Supervisor provides subject matter expertise in physician medical ... activities. This position oversees the Physician Billing (PB) Denial Coders and Appeals and Denial Coordinators, ensuring the accuracy and efficiency of denial… more
- BayCare Health System (Clearwater, FL)
- …responsibility and clinical excellence. **Summary:** + Handles and processes customer appeals and grievances in accordance with established guidelines, company ... policies, and legal regulations. + Receive and document customer appeals and grievances via multiple channels (phone, email, online portals) in systems. + Ensure… more
- Robert Half Accountemps (Durham, NC)
- …standards. Responsibilities: * Analyze and resolve confidential and sensitive appeals , grievances , and coverage/organization determinations from various ... Description We are in search of an Intake Specialist to join our team. This role is...and external medical consultants * Deliver comprehensive responses to appeals and grievances that align with the… more
- State of Colorado (Denver, CO)
- …employment laws; progressive discipline; records management; recruitment; responding to grievances , appeals , charges of discrimination; reorganization issues; ... Civil Rights Investigator - HR Specialist III - Hybrid Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4770376) Apply Civil Rights… more
- Veterans Affairs, Veterans Health Administration (IN)
- …VA Handbooks and Directives. Responds to inquiries about disciplinary actions, grievances , and appeals concerning timeliness, documentation, and other ... Summary This position serves as a VISN 20 Supervisory Human Resources Specialist - Employee Relations/Labor Relations (ER/LR) located in the Veterans Integrated… more
- LA Care Health Plan (Los Angeles, CA)
- …Compliance Quality Audit Specialist 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
- Army National Guard Units (AR)
- …EXCEPTED SERVICE POSITION This National Guard position is for a SUPERVISORY CONTRACT SPECIALIST (Title 5), Position Description Number T0044000 and is part of the AR ... employees in improving their performance. Conducts reviews of complaints and/or grievances and makes every effort to reach complaint/grievance resolutions. In… 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
- Mohegan Sun (Uncasville, CT)
- …Summary: This position clarifies company policies and procedures, investigates employee grievances and assists management in the proper interpretation and consistent ... employee performance improvement plans + Investigates and documents employee complaints and grievances to ensure compliance and a fair resolution + Assists in… more
- South Jersey Industries (Green, NJ)
- …This also involves responding to and preparing timely submissions for claims, grievances and disciplinary appeals in all procedural stages; conferencing claims ... These roles will also handle wage and time claims and any disciplinary appeals through the grievance process. Additionally, the role will serve as a point… more