• 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, 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
    LA Care Health Plan (07/08/25)
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  • Customer Solution Center Appeals…

    LA Care Health Plan (Los Angeles, CA)
    Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & ... Grievances Location: Los Angeles, CA, US, 90017 Position Type:...purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is responsible for… more
    LA Care Health Plan (08/29/25)
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  • Coord Appeals & Grievances

    AmeriHealth Caritas (Philadelphia, PA)
    …at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances , this position is responsible for the administrative tasks ... to management + Monitors to ensure that all problems with appeals/ grievances presented by plan members/participants are resolved in accordance with established… more
    AmeriHealth Caritas (08/23/25)
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  • Appeals and 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...+ Associate's Degree or equivalent experience in Appeals and Grievances **Desired Education:** + Bachelor's Degree (BS or BA)… more
    Commonwealth Care Alliance (06/06/25)
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  • Specialist, Appeals & Grievances

    Molina Healthcare (NM)
    …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 (08/30/25)
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  • Customer Solution Center Appeals…

    LA Care Health Plan (Los Angeles, CA)
    Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... 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
    LA Care Health Plan (08/26/25)
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  • Medical Director, Grievances

    UPMC (Pittsburgh, PA)
    …Medicine 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
    UPMC (08/16/25)
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  • Associate Specialist, Appeals & Grievances

    Molina Healthcare (Austin, TX)
    …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 (08/30/25)
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  • Medical Director - Medicare Grievances

    Humana (Washington, DC)
    …+ MD or DO degree + A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of ... assignment + Board Certified in an approved ABMS Medical Specialty + Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be… more
    Humana (08/26/25)
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  • Medical Director - Medicare Grievances

    Humana (Frankfort, KY)
    …+ 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, Physical Medicine and Rehab, Anesthesiology or General Surgery trained** + Excellent written and communication skills + 5… more
    Humana (08/08/25)
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