- Point32Health (TX)
- …direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible per State and Federal regulations ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
- Molina Healthcare (TX)
- …Educates providers, members and their family members of Medicare and Medicaid grievance and appeals rights. + Determines member eligibility and utilization ... departments and treating providers to effectuate timely resolution resulting from grievance and appeals decisions made at the plan level or by independent review… more
- Highmark Health (Austin, TX)
- …of a grievance /appeal; documents, investigates, refers and coordinates grievances and appeals ; initiates a case file for each grievance and appeal; ensures ... Review inquiries to determine if they meet definition of appeal/ grievance . + Request and review all related relevant documentation...+ Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement… more
- Elevance Health (Denison, TX)
- **SCA Appeals Representative I** **_Locations:_** _This is a virtual position. The ideal candidate must live within 50 miles of one of our NGS_ **_OR_** _Elevance ... - $18.15 + Louisville, KY - $17.25 The **SCA Appeals Representative I** position is an entry-level position in...review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical… more