- Molina Healthcare (Everett, WA)
- …reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
- CVS Health (Olympia, WA)
- …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
- Molina Healthcare (Spokane, WA)
- …remediate immediate and acute gaps in care and access. Assist members with filing grievances and appeals . * Connects members to CCEs, the OhioRISE Plan,or Molina ... Care Management if the members needs indicate a higher level of coordination. Provide information to members related to Molina requirements , services and benefits . * Knowledge of internal MCO processes and procedures related to Care Guide responsibilities… more