- Humana (Austin, TX)
- …CDT terminology and current professional standards o Review and resolve provider and member grievances and appeals o Provide and advance the clinical vision for ... This is accomplished by analysis and adjudication of claims, appeals , and potential quality of care issues. The Dental...or condition type. May also engage in grievance and appeals reviews and/or condition committees. Travel: While this is… more
- CVS Health (Austin, TX)
- …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