- Elevance Health (Mason, OH)
- **Title: Grievance /Appeals Analyst I** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... accommodation is granted as required by law._ " The ** Grievance /Appeals Analyst I** is an entry level position in...I** is an entry level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes… more
- OhioHealth (Columbus, OH)
- …claims defense when requested. The person will also support the patient grievance process at GMC and RMH. **Responsibilities And Duties:** 60% The Medical ... MDRM will: Support, through collaboration with Patient Experience/Customer Service, the patient grievance process. In that regard, the MDRM will assist in or provide… 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
- Molina Healthcare (Cincinnati, OH)
- …Summary** Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member ... claims appeals and grievances using support systems to determine appeal and grievance outcomes. + Requests and reviews medical records, notes, and/or detailed bills… 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
- CBRE (New Albany, OH)
- …with managers and union representatives to identify employment-related risks, support grievance handling, and manage the discovery process of investigations. + ... relations or union environment experience, with demonstrated experience in grievance handling, investigations, and CBA interpretation. Recent union experience within… more
- Central Ohio Transit Authority (Columbus, OH)
- …& past practices + Serve as the designated hearing officer during the grievance process + Serve as the management representative during the arbitration process + ... Prepare and conduct training sessions related to labor relations policies, grievance and arbitration procedures and changes to collective bargaining agreements as… more
- Molina Healthcare (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
- Molina Healthcare (Columbus, OH)
- …claims appeals and grievances using support systems to determine appeal and grievance outcomes. + Requests and reviews medical records, notes, and/or detailed bills ... as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina Healthcare guidelines. + Responsible for meeting production standards set… more