- WK Kellogg Co (Battle Creek, MI)
- …Relations, and day-to-day Labor Relations activities such as accountability, discipline, grievances , arbitrations and negotiations. You will seek and employ creative ... solutions to persistent challenges. You will be a key member of the company negotiations team preparing for and engaging in the labor negotiations process. + Training & Development - In this role, you will be responsible for ensuring delivery of appropriate… more
- Molina Healthcare (Grand Rapids, MI)
- …Duties** + Facilitates comprehensive research and resolution of appeals, disputes, grievances , and/or complaints from Molina members, providers, and related outside ... and/or regulatory timelines are met. + Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes.… more
- Molina Healthcare (MI)
- …Duties** * Facilitates comprehensive research and resolution of appeals, disputes, grievances , and/or complaints from Molina members, providers, and related outside ... and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes.… more
- Molina Healthcare (Detroit, MI)
- …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 (Grand Rapids, MI)
- …Determines appropriate language for letters and prepares responses to member appeals and grievances . * Elevates appropriate appeals to the next level for review. * ... an efficient and timely manner. * Creates and/or maintains appeals and grievances related statistics and reporting. * Collaborates with provider and member services… more
- Molina Healthcare (Ann Arbor, MI)
- …for the submission/resolution of member and provider inquiries, appeals and grievances for the Plan. Ensures resolutions are compliant. + Proactively assesses ... tracking system of correspondence and outcomes for provider and member appeals/ grievances ; oversees monitoring of each member submission/resolution to ensure all… more
- Evolent (Lansing, MI)
- …for the culture. **What You'll Be Doing:** The **Coordinator, Appeals and Grievances ** at Evolent is responsible for reviewing and processing case requests, ensuring ... GED is required. + Minimum of 3 years' experience in an Appeals and Grievances role or comparable administrative role within a health plan, managed care organization… more
- Molina Healthcare (Ann Arbor, MI)
- …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 (Warren, MI)
- …**Job Summary** Responsible for reviewing and resolving Medicare member appeals and Medicare claims in communicating resolution to members and provider (or authorized ... representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution of the appeals from Molina members, providers and… more
- Humana (Lansing, MI)
- …+ 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, or Physical Medicine and Rehab, Anesthesiology and General Surgery trained** + Excellent written and communication skills… more
