- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Grievances & Appeals Representative 2 manages client denials and concerns by ... skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 2 performs varied activities and moderately… more
- 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)
- …that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, ... you will make an impact:** + Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and regulatory… 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
- Kepro (Elkridge, MD)
- …claim resolutions and other expressions of dissatisfaction. + Refer unresolved customer grievances , appeals , and claim resolution to designated departments for ... the public sector. Acentra seeks a Senior Customer Service Representative to join our growing team. Job Summary: As...growing team. Job Summary: As a Senior Customer Service Representative , you will be a key player in our… 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
- Elevance Health (Indianapolis, IN)
- …highly desired for this role!** **The Strategy Director** supports Government Business Grievances & Appeals and Government Business Enrollment Billing. In this ... is strongly preferred. + 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
- State of Colorado (Pueblo, CO)
- …outlined by the Pueblo Regional Center. Addresses all complaints and resolving individual grievances at the home level. When a resident is placed in a ... QMAP with check off completed by designated Regional Center representative or earn QMAP within 3 months of hiring...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Denver, CO)
- …evaluating performance, including issuing corrective actions, resolving informal grievances and initiating disciplinary actions. Supervisor starts, performs, and/or ... performance problems and issues, disputes, and informal (Step 1) grievances ; issue corrective actions and initiate discipline as needed....the official appeal form signed by you or your representative . This form must be completed and delivered to… 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