- Generac Power Systems (Waukesha, WI)
- …into an energy technology solutions company, we continue to push new boundaries. The ** Appeals and Grievances Specialist ** is a critical team player who ... under general supervision with some guidance from leadership and higher-level Appeals and Grievances Specialists. **Job Responsibilities:** Case Resolution +… 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 ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- Insight Global (Los Angeles, CA)
- Job Description The Customer Solution Center Appeals and Grievances Specialist I will support the Appeals and Grievances team to receive, investigate ... -Primary function of this role is to learn the specialty level appeals and grievances work by resolving less complex cases to ensure positive outcomes for… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist RN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Nurse Specialist Registered Nurse (RN) II provides… more
- Sutter Health (Modesto, CA)
- **Organization:** MMC-Memorial Medical Center **Position Overview:** The Grievances & Appeals Specialist supports the patient and family experience through ... complaints, concerns, and other feedback received by the organizations. Complaints and grievances include, but are not limited to, the care provided by physicians… more
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** Appeals and Grievances Representative supports the Operations Department and the Appeals and Grievances team in a ... as well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** The Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and ... and resolution of cases; review, research and coordination of complaints, grievances , appeals and reconsiderations consistent with statutory and federal… more
- CDPHP (Albany, NY)
- …values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and grievance ... Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations… more
- LA Care Health Plan (Los Angeles, CA)
- …by working closely with translation vendors during the high-volume periods. The C&L Specialist II investigates and analyzes member grievances related to C&L ... Cultural and Linguistic Services Specialist II Job Category: Clinical Department: Cultural &...C&L grievance and complaint process by working closely with Appeals and Grievances (A&G) and language vendors… more
- LA Care Health Plan (Los Angeles, CA)
- …Center Compliance Audit Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: ... call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This… more
- Indian Health Service (Shiprock, NM)
- …functions: (a) adverse and disciplinary actions, (b) both administrative and union grievances and appeals , (c) employee benefits including retirement, and (d) ... AZ; 1 for Shiprock, NM. The incumbent serves as a Human Resources Specialist in the field of Employee Relations and Labor Relations which specifically includes… more
- Maryland Department of Transportation (Baltimore City County, MD)
- …and local Employment laws, advising and representing management on employee disciplinary appeals and grievances , as well as experience interacting with ... Labor Relations Specialist (Administrator III) Salary $69,323.00 - $112,044.00 Annually...of experience advising and representing management on employee disciplinary appeals and grievances , as well as experience… more
- Department of State - Agency Wide (Washington, DC)
- …Protection Board (MSPB) Acknowledgment Orders; serves as technical representative on MSPB appeals and Foreign Service Grievance Board (FSGB) grievances . Provides ... and suitability program to include policy development, discipline, adverse actions, appeals , standards of conduct, performance based actions, mediation of potential … more
- Arab Community Center for Economic and Social Serv (Dearborn, MI)
- …to access services and rights processes + Assist with resolution of local complaints, grievances , and appeals processes + Survey, track, trend, and report on ... Intake and Customer Service Specialist (Child and Adolescent Health Program) Department: Community Health & Research Center Location: Dearborn, MI START YOUR… more
- J&J Family of Companies (Albany, NY)
- …eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ); practice management; Medicare and Medicaid rules and ... Area Business Specialist , Immunology (Albany, NY) Johnson and Johnson Innovative...Innovative Medicine, Inc. is recruiting for an Area Business Specialist , Immunology for the Albany NY At Johnson &… more
- Air Mobility Command (Mcconnell AFB, KS)
- …and other federal agencies, and responses to Merit Systems Protection Board appeals , administrative and union grievances , and EEO complaints. Requirements ... known promotion potential to the target position of Human Resources Specialist (Employee Relations), GS-0201-11. Incumbent works closely with supervisor in… more
- CareOregon (Portland, OR)
- …following areas: Provider relations, managed care operations (eg, claims, appeals , grievances , customer service), medical/behavioral health clinic operations, ... Job Title Provider Relations Specialist II - Behavorial Health Exemption Status Exempt Department Provider Relations Manager Title Provider Relations Supervisor… more
- City of New York (New York, NY)
- …of Correction ("DOC" or "the Department"); - Investigate serious incidents; - Review grievances from people in custody and staff; - Evaluate the performance of DOC; ... a period of growth and change. JOB DESCRIPTION The Board seeks a Standards Specialist ("Monitor") with a passion for justice, fairness, and human rights, and the… more
- Veterans Affairs, National Cemetery Administration (Washington, DC)
- …Resolved simple, informal complaints of employees and refer others, such as formal grievances and appeals , to the Site Supervisor or an appropriate management ... Schedule: Not Available Telework: Available Position Description Title/PD#: Lead Program Specialist /PD1655715 The full performance level of this position is GS -… more
- State of Colorado (Colorado Springs, CO)
- …and respond to offender and visitor requests for ADA accommodation, grievances and correspondence by independently researching and evaluating claims and requests ... decision of offender request; + Respond to offender ADA grievances by gathering, investigating and researching pertinent information, interviewing appropriate… more