- Molina Healthcare (Kenmore, WA)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals… more
- Molina Healthcare (Doral, FL)
- …with research. * Determines appropriate language for letters and prepares responses to member appeals and grievances . * Elevates appropriate appeals ... problem-solving in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with… more
- Modivcare (Ridgeland, MS)
- …this opportunity may be the right fit for you! Modivcare is looking for an experienced Grievances & Appeals Specialist to join our team! This position is ... risk for service failure. This role + Handles high-risk member complaints and grievances . + Collects all necessary supporting information to accurately provide… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and grievance correspondence, and ... and tracking information to facilitate and expedite processing of appeals and grievances received from a variety...breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit… more
- Molina Healthcare (Madison, WI)
- … Member issues in areas involving member impact and engagement including: Appeals and Grievances , Member Problem Research and Resolution, and the ... available to them, including preventive services. * Participates in annual member complaints and appeals training with health plan, including the member … more
- State of Colorado (Denver, CO)
- CDOC Community Programs Specialist III (Re-Entry) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5190353) Apply CDOC Community Programs ... Specialist III (Re-Entry) Salary $4,906.00 - $7,849.00 Monthly Location...Defined + Contribution Plan plus 401K and 457 plans. Member Contribution Rates . Correctional Officers I-IV qualify as… more
- TEKsystems (Honolulu, HI)
- …best course of action. + Analyze sensitive member and provider appeals , inquiries, and grievances , applying internal policies, contractual provisions, and ... We are seeking a Customer Support Specialist to join a leading healthcare organization. This...critical in supporting members and providers by handling inquiries, appeals , and grievances with professionalism and accuracy.… more
- ManpowerGroup (Alexandria, MN)
- …Contact Center Specialist ** to join their team. As a Transportation Contact Center Specialist , you will be part of the Member & Provider Services Department, ... matters to appropriate departments when necessary. + Identify issues related to grievances or appeals and follow proper procedures accordingly. **What's… more
- Insight Global (San Francisco, CA)
- …to change - thrives in a fast-moving, start-up environment Experience with grievances , appeals , or quality assurance within healthcare operations Background in ... Job Description Insight Global is seeking a Remote Operations Support Specialist to join our clients growing Food Operations team. This role supports the day-to-day… more
- WelbeHealth (Madison, WI)
- …data requests during audits + Complete investigations and notifications, along with the grievances , appeals , and HPMS processes as needed **Job Requirements:** + ... the supervision of the Quality Operations Director (QOD), the Quality Operations Specialist is accountable for the maintenance and oversight of the WelbeHealth… more
- Molina Healthcare (Milwaukee, WI)
- …to healthcare premium. * Assist in resolution for escalated premium issues with Appeals and Grievances team members. * Guide and collaborates with enrollment ... party with the amount due for the healthcare program the member is enrolled. * Guide and support Member Service representatives to help them resolve member … more
- The County of Los Angeles (Los Angeles, CA)
- …personnel in their unit and effectively recommending the adjustment of grievances and disciplinary problems. Other positions are assigned such functions as: ... first level technical and administrative supervision to the complaint or advanced-level appeals unit. Essential Job Functions + Supervises the activities of all… more
- LA Care Health Plan (Los Angeles, CA)
- …Analytics Required: Experience analyzing call center operations, enrollment services, and appeals & grievances . Experience translating data into actionable ... operational Key Performance Indicators (KPIs) (eg, turnaround times, denial rates, appeals outcomes) and translate data into actionable insights. Domain Focus:… more
- LA Care Health Plan (Los Angeles, CA)
- …Analytics Required: Experience analyzing call center operations, enrollment services, and appeals & grievances . Experience translating data into actionable ... teams. Ability to analyze operational KPIs (eg, turnaround times, denial rates, appeals outcomes) and translate data into actionable insights. Domain Focus: Network… more
- LA Care Health Plan (Los Angeles, CA)
- …Analytics Required: Experience analyzing call center operations, enrollment services, and appeals & grievances . Experience translating data into actionable ... operational Key Performance Indicators (KPIs) (eg, turnaround times, denial rates, appeals outcomes) and translate data into actionable insights. Domain Focus:… more
- State of Colorado (Delta, CO)
- …Plan or PERA Defined. + Contribution Plan plus 401K and 457 plans. Member Contribution Rates . Correctional Officers I-IV qualify as "Safety Officers" and are ... hours and payroll, performs inmate performance evaluations, resolves informal grievances and makes recommendations for corrective or disciplinary actions. This… more
- State of Colorado (Delta, CO)
- …Plan or PERA Defined. + Contribution Plan plus 401K and 457 plans. Member Contribution Rates . Correctional Officers I-IV qualify as "Safety Officers" and are ... hours and pay, creates schedule and assigns tasks and resolves informal grievances ; inspects work and performs inmate evaluations; reduces inmate idleness and… more
- State of Colorado (Pueblo, CO)
- …patients. This position advocates for patients. This position participates as a member of the multidisciplinary team, mentoring new staff and students, educating ... + Addresses patient complaints/complaints of family and resolves patient grievances at the unit level. + Aware of patient...Demonstrates understanding of the role of the Patient Right Specialist and utilizes this person as a resource when… more
- State of Colorado (Sterling, CO)
- …Plan or PERA Defined. + Contribution Plan plus 401K and 457 plans. Member Contribution Rates . Correctional Officers I-IV qualify as "Safety Officers" and are ... pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness and...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)
- …Benefit Plan or PERA Defined Contribution Plan plus 401K and 457 plans. Member Contribution Rates . Correctional Officers I-IV qualify as "Safety Officers" and are ... ensuring completion of mandatory annual training. + Resolving informal grievances This position may participate in the Duty Officer...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
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