- Molina Healthcare (Kenmore, WA)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and… more
- Molina Healthcare (Doral, FL)
- …with research. * Determines appropriate language for letters and prepares responses to member appeals and grievances . * Elevates appropriate appeals to the ... in an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with provider and member… 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 ... for service failure. This role + Handles high-risk member complaints and grievances . + Collects all necessary supporting information to accurately provide a… 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
- 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 Denver Metro, CO Job Type Full Time Job Number PAR 84065 CPS III 2.2026 Department Department… more
- TEKsystems (Honolulu, HI)
- …This role is critical in supporting members and providers by handling inquiries, appeals , and grievances with professionalism and accuracy. You will work closely ... the best course of action. + Analyze sensitive member and provider appeals , inquiries, and grievances , applying internal policies, contractual provisions, and… more
- Molina Healthcare (Madison, WI)
- …Represents Member issues in areas involving member impact and engagement including: Appeals and Grievances , Member Problem Research and Resolution, and the ... or problem; informs members of their rights in the complaints and appeals process; and advises/refers as appropriate for investigation and resolution. * Conducts… more
- ManpowerGroup (Alexandria, MN)
- …matters to appropriate departments when necessary. + Identify issues related to grievances or appeals and follow proper procedures accordingly. **What's ... in healthcare services, is seeking a **Transportation Contact Center Specialist ** to join their team. As a Transportation Contact...to join their team. As a Transportation Contact Center Specialist , you will be part of the Member &… more
- Government Publishing Office (Washington, DC)
- …of data. Resolves simple, informal complaints of employees and refers formal grievances and appeals to the appropriate official. Requirements Conditions of ... Employment Qualifications To qualify for the Lead Printing Services Specialist , PG-1654-13, you must meet the following requirements: Individual Occupational… more
- J&J Family of Companies (Cherry Hill, NJ)
- …eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ); practice management; Medicare and Medicaid rules and ... **Job Description:** We are searching for the best talent for Senior Area Business Specialist to be in South New Jersey. Territory includes: Cherry Hill, Toms River,… more
- FLACRA (Clifton Springs, NY)
- …closely with Managed Care insurance providers to understand their policies, including grievances and appeals , and assist clients with advocacy as needed. ... Utilization Management Specialist FLACRA Clifton Springs, NY (Onsite) Full-Time $16.50 - $17.50/Hour Apply Now… 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
- 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
- City of New York (New York, NY)
- …of Correction ("DOC" or "the Department"); - Investigate serious incidents; - Review grievances from people in custody and staff; - Evaluate the performance of DOC; ... a period of growth and change. JOB DESCRIPTION The Board seeks a Standards Specialist ("Monitor") with a passion for justice, fairness, and human rights, and the… more
- Navy Federal Credit Union (Winchester, VA)
- …efforts, investigations, policy interpretation and resolution of employee grievances /charges. Responsibilities + Evaluate employee inquiries and problems to ... to employees and management + Represent Navy Federal in unemployment hearings and appeals , as necessary + Assist in composing internal and external communications +… 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 ... team to resolve eligibility issues affecting premium billing. * Generate billing data using the QNXT premium billing module to be sent to print and fulfillment vendor. * Reconcile unallocated payments on a daily basis. * Resolve orphan member payments on a… more
- State of Colorado (Denver, CO)
- …employment laws; progressive discipline; records management; recruitment; responding to grievances , appeals , charges of discrimination; reorganization issues; ... retention; selection and selection appeals ; settlement advice; strategic planning and overall HR guidance...troubleshoot and resolve issues. + Assists the Performance Development Specialist with the performance module in the HCM and… 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
- Volunteers of America Los Angeles (Los Angeles, CA)
- …and resolution of facts and issues in matters affecting disciplinary actions, grievances , appeals , and complaints, refers complex matters to HR Employee ... Relations Specialist or Senior Manager of Employee Relations as required...with 20+% dedicated time committed to handling employee complaints, grievances , interactive processes, and disciplinary actions. + Familiarity with… more
- State of Colorado (Delta, CO)
- …hours and payroll, performs inmate performance evaluations, resolves informal grievances and makes recommendations for corrective or disciplinary actions. This ... of the department's action. For more information about the appeals process, the official appeal form, and how to...position, please direct your inquiries to our Employee Relations Specialist , Kristen Lange , at doc_###@state.co.us or call ###… more
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