- Point32Health (TX)
- …here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
- Humana (Columbus, OH)
- …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
- Elevance Health (Harrisburg, PA)
- **SCA Appeals Representative I** **_Locations:_** _This is a virtual position. The ideal candidate must live within 50 miles of one of our NGS_ **_OR_** ... Medicaid Services to transform federal health programs. The **SCA Appeals Representative I** position is an entry-level...review tools to conduct extensive research and analyze the grievance and appeal issue(s) and pertinent claims and medical… more
- CDS Life Transitions (Webster, NY)
- …at least one of the following areas: call center operations, MLTC, grievance and appeals , and/or authorizations. Physical Requirements/Working Conditions: + Must ... benefits, please apply to find out more! Summary: A Member Services Representative is responsible for providing iCircle members with exceptional customer service. A… 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
- BrightSpring Health Services (Chattanooga, TN)
- …to Member and Provider issues. Refer all unresolved issues to the next level including grievance and appeals . + Actively market plan to new senior care partners ... Our Company Signature Advantage Overview Seeking an Account Representative for our Signature Advantage Plan who will...senior care partners within plan service area. The Account Representative will use a consultative sales approach to encourage… more
- Highmark Health (Columbus, OH)
- …and member requests, received from Medical Management & Policy (MM&P) and Member Grievance Departments. * Responsible for management of Peer to Peer telephone line. ... timely receipt, review and assignment of all incoming physician reviewer referrals and appeals to ensure that NCQA, URAC, CMS, DOH, DOL and state specific regulatory… more
- State of Colorado (Pueblo, CO)
- …and assistance in ensuring individual rights are protected, implementation of grievance processes, transition planning, and obtaining benefits as needed. + Assists ... 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
- 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
- State of Colorado (Greeley, 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
- 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
- Transdev (Dorchester, MA)
- …be called upon to testify on behalf of the Company during the Union grievance process, Accident Review Committee meetings, Safety appeals meetings, and other ... personnel so classified. The physical demands described here are representative of those that must be met by an...personnel so classified. The physical demands described here are representative of those that must be met by an… more
- Roper St. Francis (SC)
- …resolutions, receives & forwards compliments, issues acknowledgement letters, forwards grievance forms within the designated timeframe, assists with accreditation ... or healthcare preferred. Prior experience working with grievances and appeals strongly preferred. Knowledge of RSFH organizational structure strongly preferred.… more
- State of Indiana (Shelbyville, IN)
- …a welcoming, accessible, and equitable workplace with a workforce that is representative of Indiana's population. As a proud equal opportunity employer, reasonable ... dinning, working and recreational areas. + Provide testimony at hearings, trials, appeals and criminal proceedings. + Conduct searches and seizures. + Some essential… more
- City and County of San Francisco (San Francisco, CA)
- …the City in state and federal civil litigation (through trial and appeals ) and administrative proceedings involving labor and employment matters and provides ... 30 unions that represent City employees, including collective bargaining, labor grievance arbitrations, and defending unfair labor practice and other administrative… more