- 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, ... required to achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and… more
- Point32Health (Watertown, MA)
- …responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for ... + Must be able to organize, plan and implement the functions of Member Appeals and Grievances , maintain timelines and turnaround times to meet multiple… more
- Fallon Health (Worcester, MA)
- …of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and ... assigning all incoming appeals and grievances...acknowledgement of the grievance/appeal, educating the member and/or member representative about the grievance/appeal, gathering all pertinent and relevant… more
- The Cigna Group (Austin, TX)
- …to various units for final processing + Independently respond to inquiries, grievances , complaints or appeals ranging from routine to moderate complexity. ... contact center environment. The Call Center Japanese speaking Customer Service Senior Representative represents the company; our people make all the difference in… more
- CVS Health (Salem, OR)
- …claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals . + Initiates out-reach/welcome calls to ensure constituents ... heart, each and every day. **Position Summary:** Health Concierge -Customer Service Representative is the face of Aetna to provide targeted, personalized service… more
- TEKsystems (Harrisburg, PA)
- …inquiries or inform them of claim investigation outcomes. - Refer unresolved grievances , appeals , and claim resolutions to appropriate departments. - Maintain ... records of customer interactions and transactions. - Listen actively and probe callers to understand the purpose of their calls. - Research and communicate information regarding member eligibility and claim status. - Educate providers on claim submission… more
- CVS Health (High Point, NC)
- …claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals . + Initiates out-reach/welcome calls to ensure constituents ... expectations are met or exceeded. + Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase… more
- Roper St. Francis (Charleston, SC)
- …legal field, customer service or healthcare preferred. Prior experience working with grievances and appeals strongly preferred. Knowledge of RSFH organizational ... Summary** **:** The Patient Relations & Legal Coordinator aids in complaints and grievances management as well as legal matters to include coordinating with outside… more
- State of Colorado (Pueblo, CO)
- …employment laws; progressive discipline; records management; recruitment; responding to grievances , appeals , charges of discrimination; reorganization issues; ... retention; selection and selection appeals ; settlement advice; strategic planning and overall HR guidance...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
- State of Colorado (Arapahoe County, CO)
- …professional development training (as available). Resolves informal staff grievances . Provide formal/informal performance feedback. Initiate progressive discipline, ... interventions for all youth. Responds to and resolves youth grievances . Act as first public contact with agency when...the official appeal form, signed by you or your representative . This form must be delivered to the State… more