- Harbor Health Services, Inc. (Mattapan, MA)
- …quality and consistency of decisions. Supervisory responsibilities for UM RN, Quality Analyst , Appeals and Grievances Specialist. Requirements: Bachelor's ... of quality measures and other data by the Quality Analyst for report to regulatory agencies, including CMS and...communication to employees about QI efforts. Working with the Appeals and Grievances Specialist, maintains oversight of… more
- Point32Health (MA)
- …the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst is responsible per State and Federal regulations for ... responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for… more
- Point32Health (Canton, MA)
- …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
- Elevance Health (Indianapolis, IN)
- …of clinical information. + The analyst may serve as a liaison between grievances & appeals and /or medical management, legal, and/or service operations and ... **Title: Grievance/ Appeals Analyst I** **Virtual:** This role...analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types… 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
- The Cigna Group (Salem, OR)
- …Complete onsite quality assessments + Respond to provider inquiries, concerns, complaints, appeals and grievances + Provide ongoing product education to dentists ... and their staff + Work to achieve contract discounts with new providers and current providers through thoughtful negotiation + Use data and facts to identify and overcome objections + Prioritize and organize own work to meet deadlines, and reach established… more
- The County of Los Angeles (Los Angeles, CA)
- …personnel in their unit and effectively recommending the adjustment of grievances and disciplinary problems. Other positions are assigned such functions as: ... first level technical and administrative supervision to the complaint or advanced-level appeals unit. Essential Job Functions + Supervises the activities of all… more
- State of Colorado (CO)
- …eligible for overtime compensation. Department Contact Information Anita McEachern - HR Analyst at ###@state.co.us Primary Physical Work Address This is a remote ... goals and objectives. + Resolve problems, performance issues, disputes, and informal grievances and initiate corrective action or recommend discipline as needed. +… more
- Commonwealth Care Alliance (Boston, MA)
- …schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and ... to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role in ensuring accurate, compliant, and timely reimbursements… more
