- 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, CA, US, ... that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage process for… more
- Point32Health (MA)
- …. **Job Summary** Under the general direction of the Manager, Appeals and Grievances the Supervisor, Appeals and Grievances using in depth knowledge of ... and provide leadership for the daily operations of the Appeals and Grievances department. The supervisor represents the Appeals and Grievances Department… more
- Point32Health (MA)
- …. **Job Summary** Under the direction of the A&G Manager, the Appeals & Grievances QA Auditor audits the quality of letters and keyed entries from the Grievance ... identifies areas of opportunity for the A&G (Appeals and Grievances ) department. Understands department, segment, organizational strategy and operating objectives,… more
- 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...+ Associate's Degree or equivalent experience in Appeals and Grievances **Desired Education:** + Bachelor's Degree (BS or BA)… more
- 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, CA, US, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider… more
- Point32Health (Watertown, MA)
- …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
- Molina Healthcare (Buffalo, NY)
- …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 (St. Petersburg, FL)
- …requirements to meet contract and regulatory expectations. * Establishes Appeals & Grievances department policies and procedures in line with federal and state ... trends and prepares reports that identify root causes for Appeals, Grievances , and Provider Disputes. Recommends and implements process improvements to achieve… more
- UPMC (Pittsburgh, PA)
- …a board-certified physician with a Pennsylvania Medical License for a Medical Director, Grievances role with UPMC Community Health Choices. This role is fully remote ... weekly availability within the aforementioned time frame. The Medical Director, Grievances is responsible for assuring physician commitment and delivery of… more
- Molina Healthcare (Caldwell, ID)
- …that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine Provider No Surprises Act outcomes. + ... Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina… more