• Specialist , Appeals

    Molina Healthcare (Yonkers, NY)
    …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. +… more
    Molina Healthcare (06/26/25)
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  • Specialist , Appeals

    Molina Healthcare (Yonkers, NY)
    …to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine Provider No Surprises ... + Min. 2 years operational managed care experience (call center, appeals or claims environment). + Health claims processing background, including coordination… more
    Molina Healthcare (08/01/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Yonkers, NY)
    …and Marketplace request authorization. Strongly prefer candidates with a background in appeals and grievances . Excellent computer multi-tasking skills and good ... office with internet connectivity of high speed required **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for … more
    Molina Healthcare (08/02/25)
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  • Sr Specialist , Member Engagement (Remote)

    Molina Healthcare (Buffalo, NY)
    …Represents Member issues in areas involving member impact and engagement including: Appeals and Grievances , Member Problem Research and Resolution, and the ... advocate organizations, subcontractors and enrollees. * Monitors all formal and informal grievances with Grievance personnel to identify trends or problem areas of… more
    Molina Healthcare (08/02/25)
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  • Standards Specialist

    City of New York (New York, NY)
    …of Correction ("DOC" or "the Department"); - Investigate serious incidents; - Review grievances from people in custody and staff; - Evaluate the performance of DOC; ... a period of growth and change. JOB DESCRIPTION The Board seeks a Standards Specialist ("Monitor") with a passion for justice, fairness, and human rights, and the… more
    City of New York (05/23/25)
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