- Highmark Health (Santa Fe, NM)
- …of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals ; initiates a case file for each grievance and appeal; ensures ... all involved parties. + Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross… more
- Molina Healthcare (NM)
- …and documents Medicaid and Medicare Advantage denial determinations for reconsiderations/ appeals in a thorough, professional and expedient manner. May include ... + Reviews, classifies, researches, and resolves member complaints (grievances and/or appeals ) and communicates resolution in writing to members and providers or… more