• Appeals & Grievances QA Auditor

    Point32Health (MA)
    …(https://www.point32health.org/) . **Job Summary** Under the direction of the A&G Manager, the Appeals & Grievances QA Auditor audits the quality of letters and ... audit findings and identifies areas of opportunity for the A&G ( Appeals and Grievances ) department. Understands department, segment, organizational strategy… more
    Point32Health (08/07/25)
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  • Director, Appeals & Grievances

    Molina Healthcare (St. Petersburg, FL)
    …apply state level requirements to meet contract and regulatory expectations. * Establishes Appeals & Grievances department policies and procedures in line with ... and interprets trends and prepares reports that identify root causes for Appeals , Grievances , and Provider Disputes. Recommends and implements process… more
    Molina Healthcare (07/20/25)
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  • Appeals & Grievances Program Advisor

    Commonwealth Care Alliance (Boston, MA)
    011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA and other related quality program activities including: monthly case quality monitoring, coordination of… more
    Commonwealth Care Alliance (05/21/25)
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  • Manager, Customer Solution Center Appeals

    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, ... achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage… more
    LA Care Health Plan (07/08/25)
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  • Appeals & Grievances Analyst

    Point32Health (Watertown, MA)
    …responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for ... to organize, plan and implement the functions of Member Appeals and Grievances , maintain timelines and turnaround times to meet multiple requirements/regulations… more
    Point32Health (08/07/25)
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  • Customer Solution Center Appeals

    LA Care Health Plan (Los Angeles, CA)
    Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, ... to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and… more
    LA Care Health Plan (08/08/25)
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  • Specialist, Appeals & Grievances

    Molina Healthcare (Omaha, NE)
    …+ 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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  • Associate Specialist, Appeals

    Molina Healthcare (MI)
    …assist with research. + Determines appropriate language for letters and prepare responses to appeals and grievances . + Elevates appropriate appeals to the ... systems and other available resources. + Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines. +… more
    Molina Healthcare (08/09/25)
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  • Specialist, Appeals & Grievances

    Molina Healthcare (Caldwell, ID)
    …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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  • Supervisor, Appeals and Grievances

    Point32Health (MA)
    …(https://www.point32health.org/) . **Job Summary** Under the general direction of the Manager, Appeals and Grievances the Supervisor, Appeals and ... will coordinate and provide leadership for the daily operations of the Appeals and Grievances department. The supervisor represents the Appeals and … more
    Point32Health (08/07/25)
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