- Centene Corporation (Phoenix, AZ)
- …member and provider complaints, grievances and appeals + Maintain files on individual appeals and grievances + May coordinate the Grievance and Appeals ... High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals , claims, related managed care experience, or… more
- Elevance Health (Costa Mesa, CA)
- …for employment, unless an accommodation is granted as required by law._ The **Medicaid Grievance and Appeals Intake Analyst** is an entry level position in the ... Enterprise Grievance & Appeals Department that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from… more
- Sharp HealthCare (San Diego, CA)
- …and Grievance ProcessingUnder limited supervision, reviews and responds to appeals and grievances received from Commercial members and providers, in accordance ... documentation in department database to ensure accurate and thorough documentation of appeals / grievance process.Communicates both in written and oral form in a… more
- Sharp HealthCare (San Diego, CA)
- …and grievance processingUnder limited supervision, reviews and responds to appeals and grievances received from members and providers, in accordance with ... in IDX Customer Service Module to ensure accurate and thorough documentation of appeals / grievance process.Communicates both in written and oral form in a… more
- Commonwealth Care Alliance (Boston, MA)
- …**Supervision Exercised:** No **Essential Duties & Responsibilities** Processing of Grievances & Appeals : + Responsible for the progress of grievance and appeal ... pharmacy, dental, reporting, and member services. + Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in day-to-day tasks and assignments.… more
- Point32Health (MA)
- …Point32Health (https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
- AmeriHealth Caritas (Philadelphia, PA)
- …of medical management authorizations.; + Research and Investigate member and/or provider appeals and grievance requests, including review of UM/claim denial ... in a Managed Care environment + 1 to 3 years' experience in grievance / appeals environment required **The Ideal Person will have:** + Proven experience as a… more
- LA Care Health Plan (Los Angeles, CA)
- …Required: At least 5 years of experience resolving health care eligibility, access, grievance and appeals issues, preferably in health services, legal services ... Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC...Coordinates, tracks, and resolves internal and external appeal and grievance complaints for LA Care Plan Partners, including identifying… more
- LA Care Health Plan (Los Angeles, CA)
- …consistent and accurate manner. This position will focus on quality review of non-clinical grievance and appeals cases for all line of business (LOB) to identify ... and evaluation by the Management Team. Duties Focus on quality review of grievance and appeals cases for all LOB to identify areas of improvement to assist the… more
- Molina Healthcare (Lexington, KY)
- …**Job Summary** Responsible for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and ... group of employees responsible for submission, intervention and resolution of appeals , grievances, and/or complaints from Molina members, providers and related… more