- Elevance Health (Cincinnati, OH)
- **Manager II Grievance /Appeals** **- Claims Support** **Office Locations:** _The selected candidate must reside within a reasonable commuting distance of the ... accommodation is granted as required by law._ The **Manager II Grievance /Appeals** responsible for management oversight of grievances and appeals departmental units… more
- Molina Healthcare (Cleveland, OH)
- …for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for reviewing and resolving member ... state and federal regulations. Responsible for managing the Appeals and Grievance department inventories within the key performance requirements. * Coordinates with… more
- Howmet Aerospace (Cleveland, OH)
- …units. Referring conflicting positions to senior management for resolution. + Conducting Grievance hearings during the final step of the Grievance Process. ... Demonstrated knowledge, skill, and experience in contract language/negotiations, arbitration, grievance , and employment/labor law. + Excellent influencing and negotiation… 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 their ... assigned market, member population, or condition type. May also engage in grievance and appeals reviews. May participate on project teams or organizational… more
- Molina Healthcare (Toledo, OH)
- …subcontractors and enrollees. * Monitors all formal and informal grievances with Grievance personnel to identify trends or problem areas of access and care ... delivery. Assists enrollees in the grievance process at the HMO and State levels and monitors outcomes. * Provides timely written responses to inquiries; prepares… more
- Molina Healthcare (Akron, OH)
- …7 years' experience in healthcare claims review and/or Provider appeals and grievance processing/resolution, including 2 years in a manager role. * Experience ... DRG/RCC pricing), and IPA. + 2 years supervisory/management experience with appeals/ grievance and/or claims processing within a managed care setting. **Preferred… 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 their ... in an assigned market, member population, or condition type. May also engage in grievance and appeals reviews. Some medical directors may join a centralized team for… more
- Cleveland Clinic (Cleveland, OH)
- …CMS and CC Enterprise guideline and regulations pertaining to complaint and grievance process. Minimum Qualifications for the ideal future caregiver include: + ... Associate's Degree OR minimum of 5 years administrative, customer service and/or call center experience. + Proficiency with spreadsheet, word processing and database software Preferred qualifications for the ideal future caregiver include: + Complaint… more
- Alkegen (Sebring, OH)
- …environment, including involvement in labor relations, contract interpretation, grievance resolution, and fostering constructive relationships with union ... representatives. + Experience with ISO 9001, IATF, ISO 14001, and ISO 45001 systems implementation and compliance. + Demonstrates strong leadership presence with the ability to inspire, engage, and hold teams accountable. + Highly analytical and data-driven;… more
- Howmet Aerospace (Cleveland, OH)
- …Managing employee and labor relations effectively including contract administration, grievance handling and day-to-day employee complaints/issues. + Meeting or ... exceeding production goals, which includes monitoring output, safety, on time delivery, and people initiatives within a traditional unit supervisor role. + Directing the implementation of Howmet Aerospace Business System initiatives (lean manufacturing)… more
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