- Elevance Health (Indianapolis, IN)
- Job Description **Title: Grievance / Appeals Analyst I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live ... within 50 miles of one of our PulsePoint locations. The ** Grievance / Appeals Analyst I** is an entry level position in the Enterprise Grievance & Appeals … 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 ... **What You'll Be Doing:** - Processing of Grievances & Appeals . - Responsible for the progress of grievance... Appeals . - Responsible for the progress of grievance and appeal intervention and resolution. - Assure verbal… more
- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, September 9, 2024 Centers Plan for Healthy Living's goal ... the guidance and plans they need for healthy living. JOB SUMMARY: The Grievance & Appeal Clinical Reviewer performs complex medical necessity reviewed on Initial… more
- Humana (Tallahassee, FL)
- …of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Grievances & Appeals Representative 2 manages client denials and concerns by conducting a ... with clinical and other Humana parties. The Grievances & Appeals Representative 2 performs varied activities and...call center or related customer service experience + Previous grievance and appeals experience + Medical terminology… more
- MTA (New York, NY)
- …and participate in monthly conferences with union representatives to discuss contract grievance and employee discipline appeals ; perform analytical review of ... Senior Labor Relations Representative Job ID: 6749 Business Unit: MTA Headquarters...sanctioned by the National Mediation Board for all contract grievance and employee discipline cases. + Provide leadership and… more
- Commonwealth Care Alliance (Boston, MA)
- …members and all those involved in CCA members' care. The Member Service Representative (MSR) is responsible to provide a best-in-class service experience to all ... including provider listings in their areas. + Complete comprehensive appeal and grievance intakes. + Collaborate with the member to accurately document their appeal… more
- CVS Health (Oklahoma City, OK)
- …Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. + Educates ... customer-focused professionals supported by exemplary technologies and processes. Customer Service Representative is the face of Aetna and impacts members' service… more
- Highmark Health (Dover, DE)
- …This position is also responsible for assisting members in navigating the grievance and appeals process and representing member interests internally and ... Service **Preferred** + Familiarity as a Member Advocate or with complaint and grievance processes + Familiarity with Delaware Medicaid and the Medicaid LTSS benefit… more
- Veterans Benefits Administration (St. Paul, MN)
- Summary The Supervisory Veterans Service Representative (AVSCM) shares in the responsibility of managing Veterans Service Center (VSC) division operations through a ... not a virtual position. Position Description/PD#: Supervisory Veterans Service Representative (AVSCM); PD# 37977A Relocation/Recruitment Incentives: Authorized. Relocation expenses… more
- CVS Health (Columbus, OH)
- …+ Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system . + ... Educates & assists providers on our self-service options. Assists providers with credentialing and re-credentialing and contracting questions and issues. + Assists in compiling claim data for customer audits. Determines medical necessity, applicable coverage… more
- TEKsystems (Rancho Cordova, CA)
- …billing reconciliation and rebill accounts when needed Respond from emails that comes from appeals and grievance department Ensure bills are released on time to ... members Making sure accuracy meets service agreements * 2 years of billing accounts receivable or accounting experience Experience Level: Expert Level #prioritywest About TEKsystems: We're partners in transformation. We help clients activate ideas and… more
- CDS Life Transitions (Webster, NY)
- …in at least one of the following areas: call center operations, MLTC, grievance and appeals , and/or authorizations. The listed salary range represents the ... organization's good faith and reasonable estimate of the range of possible compensation at the time of posting. The offered salary will be determined by: Applicant qualifications and experience, education, position specific licensing/training and departmental… more
- Sacramento County (Sacramento, CA)
- …Sacramento County service in the class of Senior Personnel Analyst or Labor Relations Representative . Or: 2. Four years of experience in a human resources or labor ... duties, including a minimum of one year experience in discipline, grievance investigation, arbitration, or labor negotiations (public sector experience is highly… more
- Montana State University (Bozeman, MT)
- …will perform all customer service duties, coordinate the unit's citation appeals process, and provide administrative support. Performs of customer service functions ... + Maintain accurate databases and various digital and paper records. + Screen citation appeals for recommendations to the appeals board. + Schedule and conduct… more
- State of Colorado (Golden, CO)
- …team meetings in collaboration with CYSO III + Ensure that youth grievance policy and procedure are followed. Review of grievances to include investigation, ... the official appeal form, signed by you or your representative . This form must be delivered to the State...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Department of State - Agency Wide (Washington, DC)
- …Board (MSPB) Acknowledgment Orders; serves as technical representative on MSPB appeals and Foreign Service Grievance Board (FSGB) grievances. Provides advice ... and suitability program to include policy development, discipline, adverse actions, appeals , standards of conduct, performance based actions, mediation of potential… more
- State of Colorado (CO)
- …referrals and consultations, medical reporting, medical co-signature and inmate grievance requirements are completed in accordance with DOC Administrative ... the official appeal form, signed by you or your representative . This form must be delivered to the State...of the department's action. For more information about the appeals process, the official appeal form, and how to… more