- VNS Health (Manhattan, NY)
- …issues pertaining to State Fair Hearings. Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents arguments in defense ... + Enters data and assists with compiling reports and analysis on the grievance and appeals process. For Fair Hearings: + Supports Grievance and Appeals… 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 ... complaints, appeals and grievance cases for products for all lines of business. Responsibilities include, but are not limited to: timely classification and… more
- LA Care Health Plan (Los Angeles, CA)
- …meet and/or exceed member satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring work, providing ... assisting with the development of a successful and cohesive Appeals and Grievance unit, with a high...and or process improvement. Assist Supervisor to ensure that Specialist provide accurate, timely, and quality responses. Ensure that… more
- BayCare Health System (Clearwater, FL)
- …must reside in Florida Equal Opportunity Employer Veterans/Disabled **Position** Intake Specialist Appeal and Grievance - Health Plan **Location** ... and clinical excellence. **Summary:** + Handles and processes customer appeals and grievances in accordance with established guidelines, company policies,… 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 Angeles, CA, ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… 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, ... areas to implement those changes. **Responsibilities** . Reviews and evaluates appeal/ grievance requests and electronic inquiries in order to identify and classify… more
- Molina Healthcare (Columbus, OH)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance … more
- LA Care Health Plan (Los Angeles, CA)
- …track all due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist .; submit all Grievances and Appeals ... Summary The Authorization Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the… 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 ... of complaints and/or grievances and makes every effort to reach complaint/ grievance resolutions. In situations involving complaints and/or grievances of a serious… more
- Henry Ford Health System (Grand Blanc, MI)
- …facilities and locations as needed. As a strategic partner, the Labor Relations Specialist provides HR and Labor Relations support to leaders and associates within ... active participation in the negotiations of collective bargaining agreements, manage grievance procedures to handle complaints from unionized employees, and advise… more
- South Jersey Industries (Green, NJ)
- …objectives. These roles will also handle wage and time claims and any disciplinary appeals through the grievance process. Additionally, the role will serve as a ... to and preparing timely submissions for claims, grievances and disciplinary appeals in all procedural stages; conferencing claims timely and determining the… more
- Elevance Health (Grand Prairie, TX)
- …of customer service and manages adjustments, ITS processing, keying, rate negotiation, grievance and appeals , escalations, etc., in providing a seamless Blue ... **Title: Plan to Plan Service Specialist I** **Location:** This position will work a...internal business partners (sales, member experience, claims, medical review, appeals , etc.) and external contacts within the other Blues… more
- Naval Sea Systems Command (Newport, RI)
- …experience must demonstrate the following: applying labor (collective bargaining, grievance administration, unfair labor practices, negotiability appeals ) and ... Summary You will serve as a SUPERVISORY ADMINISTRATIVE/TECHNICAL SPECIALIST in the Corporate Operations Department, Human Resources Division, Labor and Employee… more
- State of Massachusetts (Norfolk, MA)
- …ensuring accuracy of information to be transferred to the database; Enter grievance and disciplinary appeals as directed; conduct CJIS background checks ... given to those applicants that apply within the first 14 days.* Office Support Specialist I: Applicants must have at least (A) two years of full-time, or equivalent… more
- Department of State - Agency Wide (Rosslyn, VA)
- …such as Equal Employment Opportunities (EEO), Civil Rights and suitability and grievance cases. Responsibilities Maintains oversight and review of the Freedom of ... writing FOIA and PA related correspondences denial letters, amendments, affidavits, appeals , justifications and other legal documentations. OR B. Have a master's… more
- Healthfirst (NY)
- …stakeholders (including, but not limited to Regulatory, Claims Configuration, Provider Ops, Appeals & Grievance , Medical Management, Enrollment & Billing, Sales) ... to identify, scope and accurately implement new benefits, services, or other product changes, update processes and/or edit systems to accommodate regulatory requirements + Assist with ad hoc projects such as focus group studies, process improvement initiatives… more
- Johns Hopkins University (Baltimore, MD)
- …actions and make sound recommendations to management. + Manage the grievance process, including fact finding, reviewing evidence, serving as hearing officer, ... as an advisor to employees and management on employee appeal and grievance issues. + Work in partnership with department management regarding appropriate… more
- State of Colorado (CO)
- …referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance with DOC Administrative ... of the department's action. For more information about the appeals process, the official appeal form, and how to...position, please direct your inquiries to our Employee Relations Specialist , Ana Andersen at doc_###@state.co.us or call ### ALL… more
- LA Care Health Plan (Los Angeles, CA)
- …Summary The Supervisor, Authorization Technician supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the ... inventory of referral authorizations, retrospective reviews, concurrent reviews and grievance /appeal requests, and prepares UM Activity and Weekly Compliance… more
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