• Lead Specialist, Appeals & Grievances

    Molina Healthcare (FL)
    …of employees responsible for submission, intervention and resolution of appeals, grievances , and/or complaints from Molina members, providers and related outside ... provides guidance to others with respect to the more complex appeals and grievances . + Research and resolves escalated issues including state complaints and high… more
    Molina Healthcare (08/24/25)
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  • Specialist, Appeals & Grievances

    Molina Healthcare (Tampa, FL)
    …for the comprehensive research and resolution of the appeals, dispute, grievances , and/or complaints from Molina members, providers and related outside agencies ... internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. + Requests… more
    Molina Healthcare (08/30/25)
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  • Associate Specialist, Appeals & Grievances

    Molina Healthcare (FL)
    …Determines appropriate language for letters and prepare responses to appeals and grievances . + Elevates appropriate appeals to the Appeals Specialist. + Generates ... and mails denial letters. + Assists with interdepartmental issues to help coordinate problem solving in an efficient and timely manner. + Creates and/or maintains statistics and reporting. + Works with provider & member services to resolve balance bill issues… more
    Molina Healthcare (08/30/25)
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  • Appeals and Grievances Clinical Specialist…

    Healthfirst (FL)
    …+ Experience in clinical practice with experience in appeals & grievances , claims processing, utilization review or utilization management/case management. + ... Demonstrated understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines + Ability to work independently on several computer applications such as Microsoft Word and Excel, as well as… more
    Healthfirst (08/27/25)
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  • Medical Director - Medicare Grievances

    Humana (Tallahassee, FL)
    …+ 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 (08/26/25)
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  • Medical Director - Medicare Grievances

    Humana (Tallahassee, FL)
    …+ 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
    Humana (08/08/25)
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  • Director, Operational Oversight (Medicare/Duals)…

    Molina Healthcare (St. Petersburg, FL)
    …must follow, and you keep complaint data synchronized across appeals & grievances , enrollment, claims, pharmacy, and quality functions. You surface systemic issues, ... Integration - Embed CTM insights into downstream operations-Stars, appeals & grievances , enrollment, claims-so each team addresses systemic defects. 3. Capabilities… more
    Molina Healthcare (08/19/25)
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  • Broker Supervisor, Marketplace (Remote)

    Molina Healthcare (Jacksonville, FL)
    …and independent contracting, down line broker applications commissions, Broker Agent appeals/ grievances , educating Brokers on plan benefits in all markets, managing ... the detailed process of broker commission reconciliation * Handles Broker Agent appeals/ grievances . * Educates Brokers on plan benefits in all markets. * Makes… more
    Molina Healthcare (08/30/25)
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  • HR Partner (Arizona or Utah)

    BioLife Plasma Services (Tallahassee, FL)
    …BioLife business. + Analyzes trends in turnover, hiring, promotion, separation, grievances , etc. to recommend preventative actions needed to adjust unfavorable ... exit interviews, analyze trends in turnover, hiring, promotions, separations, and grievances to determine support or action needed to adjust unfavorable trends;… more
    BioLife Plasma Services (08/29/25)
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  • Operations Manager

    Transdev (Sarasota, FL)
    …and analyze performance; handle interdepartmental issues; resolve employee issues and grievances ; improve processes and route scheduling. + Makes hiring decisions ... to details + Ability to work effectively with labor; may include labor grievances and negotiations + Subject to DOT drug testing and physical if applicable.… more
    Transdev (08/28/25)
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