- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by ... trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced… 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 ... as well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is… more
- Elevance Health (Indianapolis, IN)
- **Title: Grievance/ Appeals Representative 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 Representative I** is responsible for reviewing,...impact:** + Conducts investigation and review of customer grievances and appeals involving provision of service… more
- Centers Plan for Healthy Living (Margate, FL)
- …in related area of responsibility, (ie utilization management, quality management, grievances , and appeals ) Type of Experience Required: Strong analytical ... RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate,...PHYSICAL REQUIREMENTS : The physical requirements described here are representative of those that must be met by an… more
- Concentrix (Albuquerque, NM)
- …their insurance related needs. Examples include: Inquiries regarding benefits, eligibility, appeals , grievances and troubleshooting medical devices. All while ... Job Title: Customer Service Representative (Healthcare) - Remote Job Description The Remote...(Healthcare) - Remote Job Description The Remote Customer Service Representative , works from home and interfaces with customers via… 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 ... representatives/officials to discuss and resolve employee performance issues, complaints or grievances . Promotion Potential: This position is being announced at the… more
- MTA (New York, NY)
- …with union representatives to discuss contract grievance and employee discipline appeals ; perform analytical review of claims, grievances , and discipline ... Senior Labor Relations Representative Job ID: 6749 Business Unit: MTA Headquarters...24, 2024 Description JOB TITLE : Senior Labor Relations Representative SALARY RANGE : $90,000 - $100,000 HAY POINTS… more
- Commonwealth Care Alliance (Boston, MA)
- …lines or medical setting preferred + Prior experience with service authorizations, grievances and appeals , scheduling medical appointments preferred + Ability to ... 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… more
- CVS Health (Hartford, CT)
- …claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals . + Initiates out-reach/welcome calls to ensure constituents ... and affordable. **Onsite in Hartford, CT required** **Customer Service Representative ** **Shift, Training, and Salary:** Training: 8am-4:30pm Shift: 8am to… more
- CVS Health (Sacramento, CA)
- …claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals . * Initiates out-reach/welcome calls to ensure constituents ... expectations are met or exceeded. Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase… more
- City of New York (New York, NY)
- …jurisdiction of the Department of Correction" - Investigate serious incidents - Review grievances from people in custody and staff - Evaluate the performance of the ... perform other duties as determined by the General Counsel. Appeals Under the Board's Minimum Standards, whenever DOC decides...requirement applies to you, please discuss with the agency representative at the time of interview. Qualifications 1. A… more
- State of Colorado (Trinidad, CO)
- …Individualized Program Instruction/Tutoring, Multi-Disciplinary Staffing, Responding to Inmate Grievances and Resolving Inmate Issues, Inmate Housing Placement and ... hearings, ICC, Multi disciplinary staffing, vetting responses to inmate grievances etc. Therefore, experience as an entry level officer...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
- Elevance Health (Indianapolis, IN)
- …certification will be considered.** **The Strategy Director** supports Government Business Grievances & Appeals and Government Business Enrollment Billing. In ... for this role. + Business knowledge in Government Health Benefits to include Grievances & Appeals and/or Enrollment Billing preferred. + Master's degree… 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 (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
- Sacramento County (Sacramento, CA)
- …Free Workplace Act + Principles and methods for investigating and resolving grievances and complaints + Principles and practices of organizational behavior and ... resource problems and concerns + Analyze, investigate, evaluate and resolve grievances , complaints and disciplinary matters + Counsel employees + Effectively… more
- Centers Plan for Healthy Living (Brooklyn, NY)
- …+ Follow both nursing home and CPHL reporting procedures for incidents, appeals , grievances EDUCATION AND EXPERIENCE: Education Required: Master's level degree ... Scope of responsibilities include building connections with members, designated representative and the interdisciplinary care team (ICT) through assessing needs,… more
- State of Colorado (CO)
- …makes recommendations to hire, promote or transfer; + Manages informal grievances , provides documentation to support corrective actions when needed; + Oversees ... Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel...the official appeal form, signed by you or your representative , and received at the following address within 10… more
- State of Colorado (Canon City, CO)
- …hours and pay, creates, schedules, and assigns tasks, and resolves informal grievances according to agency policy while reducing inmate idleness and creating real ... 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 (Limon, CO)
- …and ensuring the completion of annual training; + Resolve conflict and informal grievances at the lowest level possible; + Ensure safe, efficient, compliant and cost ... 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