- Generac Power Systems (Waukesha, WI)
- …energy technology solutions company, we continue to push new boundaries. **Job Summary:** The ** Appeals and Grievances Specialist ** is a critical team player ... 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
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II is primarily responsible for the… 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
- UCLA Health (Los Angeles, CA)
- …be responsible for: + Managing the intake and resolution of member and provider appeals and grievances in compliance with CMS (Centers for Medicare & Medicaid ... in healthcare operations, managed care, or Medicare Advantage, specifically in handling appeals and grievances preferred * Experience in interpreting CMS… more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... purpose. Job Summary The Lead of Customer Solution Center Appeals and Grievances is responsible for assisting...satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances , appeals and external reviews for VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage (MA), Fully ... or appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers....Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents arguments in… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …will consider collective experience, training and education. . 5 years as an Appeals Specialist or equivalent experience in Medicare health insurance claims, ... requests and electronic inquiries in order to identify and classify appeals and grievances as outlined in policies and procedures. Using internal systems,… more
- Commonwealth Care Alliance (Boston, MA)
- CCA- Appeals & Grievances Processing of Grievances & Appeals : * Responsible for the progress of grievance and appeal intervention and resolution. * Assure ... work collaboratively with CCA departments to help manage and resolve member appeals and grievances . * Act as a liaison between multiple departments to ensure the… 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)
- …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
- Commander, Navy Installations (Bangor, WA)
- …civilian personnel policies and procedures in employee relations matters (eg, discipline, grievances , appeals , fair employment practices). You will identify the ... Summary You will serve as a HUMAN RESOURCES SPECIALIST (EMPL REL/LABOR REL) in the HUMAN RESOURCES...the technical aspects of personnel administration during formal hearings, grievances , and appeals . (NOTE: Your answer must… 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
- Henry Ford Health System (Grand Blanc, MI)
- …bargaining agreement negotiations, mediation, and arbitration. + Experience in handling grievances / appeals required and prior involvement in arbitration. + Prior ... facilities and locations as needed. As a strategic partner, the Labor Relations Specialist provides HR and Labor Relations support to leaders and associates within… more
- Mohegan Sun (Uncasville, CT)
- …Summary: This position clarifies company policies and procedures, investigates employee grievances and assists management in the proper interpretation and consistent ... employee performance improvement plans + Investigates and documents employee complaints and grievances to ensure compliance and a fair resolution + Assists in… more
- Naval Air Systems Command (San Diego, CA)
- …You will provide assistance in the areas of discipline, adverse actions, grievances , employee counseling and related functions. You will research facts, legal ... support proposed or final actions. You will respond in writing to appeals or prepare documents for hearings. Requirements Conditions of Employment Qualifications… more
- US Army Communications Electronics Command (Tobyhanna, PA)
- …Resolve simple, informal complaints of employees and refer others, such as formal grievances and appeals , to the supervisor or an appropriate management ... Resolve simple, informal complaints of employees and refer others, such as formal grievances and appeals , to the supervisor or an appropriate management… more
- US Pacific Fleet, Commander in Chief (Pearl Harbor, HI)
- …of management-employee relations matters such as performance and conduct issues, grievances , appeals , or labor-management partnership; preparing draft agreements ... Summary You will serve as a HUMAN RESOURCES SPECIALIST (LABOR RELATIONS/EMPLOYEE RELATIONS) in the HUMAN RESOURCES OFFICE HAWAII, LABOR/EMPLOYEE RELATIONS DEPARTMENT… more
- Naval Facilities Engineering Command (Naval Base, VA)
- …personnel policies and procedures in employee relations matters (eg, discipline, grievances , appeals , fair employment practices). Requirements Conditions of ... Summary You will serve as a LEAD HUMAN RESOURCES SPECIALIST (LABOR REL/EMPLOYEE REL) within the Labor and Employee Relations Branch of NAVFAC ENGINEERING CMD… more