- Molina Healthcare (WI)
- …**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 (Canton, MA)
- …be doing** + Assign new verbal and written appeals and grievances to Appeals and Grievances Analyst + Process Fast Track Appeals including ... regulations, for assisting with all operational aspects of the Appeals and Grievances assignment process for Point32Health....Support A&G Analyst in timely completion of Appeals and Grievances + Adheres to all… 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
- Henry Ford Health System (Troy, MI)
- …for the prompt and thorough investigation of medical and pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): Commercial, Medicare ... AND RESPONSIBILITIES: + Conduct the primary investigation and resolution of member appeals and grievances following established guidelines from: The Center for… more
- Highmark Health (Columbus, OH)
- …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
- City and County of San Francisco (San Francisco, CA)
- …bargaining agreements. + Key duties include negotiating resolutions to grievances , investigating complaints of serious employee misconduct, and conferring with ... professional human resources experience, similar to 1241 Human Resources Analyst , in one or more of the following areas...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… more
- LA Care Health Plan (Los Angeles, CA)
- …Physical Requirements Light Additional Information Department Specifics: Customer Solution Center Appeals and Grievances : This position requires work after ... Business Analyst III Job Category: Claims Department: Claims Data...required to achieve that purpose. Job Summary The Business Analyst III facilitates business process improvement via the methodical… more
- LA Care Health Plan (Los Angeles, CA)
- Regulatory Compliance Quality Audit Specialist Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This… more
- University of Kansas (Lawrence, KS)
- …optimize dashboards that support SPS and its constituents. + Collaborate with enrollment Analyst to gather, analyze, and distribute point in cycle reports to inform ... the research, instruction and/or service of the School. + Manage petitions, grievances , and other special processes within SPS. These could include student… more