- 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 (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
- 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 (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
- 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 (Orlando, 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
- 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
- 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
- Omni Hotels (Fort Lauderdale, FL)
- …Collective Bargaining Agreement for their areas. + Handle union issues including grievances , mediations and arbitrations. + Fulfill all the responsibilities of the ... experience conducting investigations, managing the coaching and counseling and handling grievances . + Must have a well-rounded Human Resources background with solid… more
- Point32Health (FL)
- …coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for all lines of business. **Job ... organize, plan and implement the functions of Member Appeals and Grievances , maintain timelines and turnaround times to meet multiple requirements/regulations… more
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