- Elevance Health (Los Angeles, CA)
- **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...processes non-complex pre service and post service grievances and appeals requests from customer types (ie member ,… more
- Elevance Health (Columbus, GA)
- **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...processes non-complex pre service and post service grievances and appeals requests from customer types (ie member ,… more
- Elevance Health (Richmond, VA)
- …grievances and appeals requests in the Enterprise Grievance & Appeals Department from customer types (ie member , provider, regulatory, and third party) ... **Title: Grievance / Appeals Analyst II** **Location:** This position...They are how we achieve our strategy, power our business outcomes and drive our shared success - for… more
- Elevance Health (Bon Air, VA)
- **Title: Grievance / Appeals Analyst Lead** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of ... a PulsePoint location. The ** Grievance / Appeals Analyst Lead** will be responsible for...They are how we achieve our strategy, power our business outcomes and drive our shared success - for… more
- Elevance Health (Columbus, OH)
- **Manager II Grievance / Appeals - Claims Support** This position will work in a hybrid model (remote and office). Ideal candidates will live within 50 miles of ... one of our PulsePoint locations. The **Manager II Grievance / Appeals ** is responsible for management oversight of...vary depending on the above factors as well as market/ business considerations. No amount is considered to be wages… 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,...a minimum of 1 year experience in health insurance business including customer service experience; or any combination of… 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
- Henry Ford Health System (Troy, MI)
- …for the prompt and thorough investigation of medical, transportation, and pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): Commercial, ... RESPONSIBILITIES:\ + Conduct the primary investigation and resolution of member appeals and grievances following established guidelines...related field. + At least two (2) years of member appeal and grievance experience . +… more
- CVS Health (Richmond, VA)
- …from multiple business units. Ensure timely, customer focused response to appeals , complaints and grievance . Identify trends and emerging issues and report ... -Identify and research all components within member or provider/practitioner appeals , complaints and grievance for all products and services. -Triage… more
- BayCare Health System (Clearwater, FL)
- …ensuring adherence to regulatory requirements. + Triage, plan, and execute intake of Appeals and Grievance submissions. + Keeping track of deadlines, ensuring ... **Education:** + Associate's degree - related field **Experience:** + 3 years Appeals and Grievance . **Facility:** BayCare Health System **Location:** **Park… more
- Elevance Health (Columbus, OH)
- …for the management oversight of receipt, investigation and processing associated with member /provider grievances and appeals . **How you will make an impact:** ... issues including executive and regulatory grievances. + May perform internal audits of grievance and appeals process. + Monitors trends and analyzes grievance… more
- Commonwealth Care Alliance (Boston, MA)
- …ensure work is completed timely and in compliance. + Leads and represents Member Appeals and Grievances-relatedexternal CMS audits, NCQA Standards, state audit ... + Develop and execute on strategic opportunities to improve appeals & grievance process to support a...A&G operation that is efficient and effective in managing member appeals . + Work collaboratively within … more
- Elevance Health (Rancho Cordova, CA)
- …**How you will make an impact:** + Conducts investigations and reviews of member and provider medical necessity appeals . + Reviews prospective, inpatient, or ... **Nurse Appeals - Licensed RN Nurse** **Location:** This position...timely to meet regulatory timeframes. + Documents and logs appeal/ grievance information on relevant tracking systems and mainframe systems.… more
- Humana (Tallahassee, FL)
- …Degree + Previous inbound call center or related customer service experience + Grievance and appeals experience + Bilingual (English and Spanish); with the ... and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by...review of clinical documentation to determine if an a grievance , appeal or further request is warranted and then… more
- CareFirst (Baltimore, MD)
- …and post-payment stages. + Directs and ensures the efficient operational management of member appeals and grievance departments/function with emphasis on ... and the consequences of those decisions by way of appeals , for all lines of business that...Appeals , Grievances & Clinical Medical Review: Oversees the Appeals and Grievance function as well as… more
- CareOregon (Portland, OR)
- …and process to members, providers and CareOregon staff. + Perform intake of member and provider appeals & reconsiderations, gather data & documentation and ... appeals and notify members and providers of outcome. + Assist the Appeals & Grievance Coordinators, Pharmacists, Medical Directors and Quality Improvement… more
- Prime Care Coordination (Webster, NY)
- …at least one of the following areas: call center operations, MLTC, grievance and appeals , and/or authorizations. Physical Requirements/Working Conditions: + Must ... Summary: A Member Services Representative is responsible for providing iCircle...impose an undue hardship on the operation of our business . If you are interested in applying for an… more
- Hackensack Meridian Health (Edison, NJ)
- …and serve as a leader of positive change. The Manager, Regional Team Member Relations reports to the Dir, TM Relations and participates in the development, ... center of excellence strategy for their respective region or business line which is aligned to the broader organizational...day in the life of a **_Manager, Regional Team Member Relations_** at Hackensack Meridian Health includes: + Seen… more
- Humana (Columbus, OH)
- …Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within ... Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease... population, or condition type. May also engage in grievance and appeals reviews. Some medical directors… more
- The Cigna Group (Bloomfield, CT)
- …with every other weekend (Tuesday ALT Day).** + Must have experience in Medicare Appeals , Utilization Case Management or Compliance in Medicare Part C + Ability to ... differentiate different types of requests Appeals , Grievances, coverage determination and Organization Determinations in order to ensure the correct processing of… more