- Molina Healthcare (TX)
- …**Knowledge/Skills/Abilities** + Reviews, classifies, researches, and resolves member complaints ( grievances and/or appeals ) and communicates resolution in ... and documents Medicaid and Medicare Advantage denial determinations for reconsiderations/ appeals in a thorough, professional and expedient manner. May include… more
- Point32Health (TX)
- …general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible per State and Federal regulations ... responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for… more
- Highmark Health (Austin, TX)
- …they meet the definition of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals ; initiates a case file for each grievance ... parties. + Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross functional… more
- Elevance Health (Denison, TX)
- …of clinical information. + The analyst may serve as a liaison between grievances & and appeals and /or medical management, legal, and/or service operations, ... Department that reviews analyzes and processes non-complex pre-service and post-service grievances and appeals requests from customer types (ie member,… more