- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage process for… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & ... Grievances Location: Los Angeles, CA, US, 90017 Position Type:...purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Coordinator I(Temp) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Coordinator I supports the Customer Solution Center Appeals & Grievance… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider… more
- Humana (Sacramento, CA)
- …+ MD or DO degree + A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of ... assignment + Board Certified in an approved ABMS Medical Specialty + Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be… more
- Humana (Sacramento, CA)
- …+ MD or DO degree + A current and unrestricted license in at least one state and willing to obtain license, as required, for various states in region of assignment + ... Board Certified in an approved ABMS Medical Specialty + **Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, Physical Medicine and Rehab, Anesthesiology or General Surgery trained** + Excellent written and communication skills + 5… more
- Sharp HealthCare (San Diego, CA)
- …for the investigation, documentation and resolution of Commercial member appeals and grievances in compliance with State law, rules, and guidelines; provider and ... (CMO) who is responsible for all decisions regarding clinical appeals and grievances and the Chief Operations Officer (COO) who is responsible for non-clinical… more
- Sharp HealthCare (San Diego, CA)
- …Responsible for the investigation, documentation and resolution of member appeals and grievances in compliance with State law, rules, and guidelines; provider and ... (CMO) who is responsible for all decisions regarding clinical appeals and grievances and the Chief Operations Officer (COO) who is responsible for non-clinical… more
- Elevance Health (Los Angeles, CA)
- …that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, regulatory ... quality of care issues to include executive and regulatory grievances . **How you will make an impact:** +...an impact:** + Reviews, analyzes and processes non-complex grievances and appeals in accordance with external accreditation and… more
- Humana (Sacramento, CA)
- …a part of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a ... and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support… more