- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I... team to receive, investigate and resolve member and provider complaints and appeals ; escalates complex issues… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances ... safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate… more
- Modivcare (Ridgeland, MS)
- …this opportunity may be the right fit for you! Modivcare is looking for an experienced Grievances & Appeals Specialist to join our team! This position is ... role will work identify root causes of issues and provide real time solutions for members that have a...failure. This role + Handles high-risk member complaints and grievances . + Collects all necessary supporting information to accurately… more
- Molina Healthcare (Tampa, FL)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals… more
- LA Care Health Plan (Los Angeles, CA)
- …due dates for each file. Inform nurses of a new case received from Grievance and Appeals Specialist .; submit all Grievances and Appeals response letters ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....the retrospective review process for authorizations and Member or Provider Appeals , including, but not limited to… more
- Centene Corporation (Nashville, TN)
- …reporting and directories as well as claims payment resolution as it relates to provider set up. Provide support to external provider representatives to ... division of financial responsibility interpretation, contract rate and language interpretation, appeals , grievances and eligibility. + Serve as primary point… more
- BayCare Health System (Clearwater, FL)
- …is completed and filed appropriately, and communicating effectively with all parties involved. + Provide reports on the status of grievances and provide ... updates to management. + Identify trends or recurring issues in member grievances and appeals and recommend process improvements to prevent future occurrences. +… more
- US Marine Corps (Quantico, VA)
- …investigations and leave administration. Performs and reviews trend analysis of grievances , unfair labor practices, complaints, and appeals , and develops ... in effecting disciplinary actions, removals, suspensions, and in resolving grievances and appeals related to formal disciplinary...basis. It is Department of Navy (DON) policy to provide a workplace free of discrimination and retaliation. The… more
- Tufts Medicine (Boston, MA)
- …research breakthroughs to life. **Job Overview** The Senior Employee & Labor Relations Specialist serves as a trusted subject matter expert and strategic partner to ... This is an individual contributor role requiring the ability to provide leadership when resolving the unique employee relations challenges of multi-disciplinary… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …healthcare? Bring your true colors to blue. The Role:The Peer Review Specialist is responsible for monitoring the quality of the credentialed practitioner/ ... organizational provider networks ensuring our members receive the highest quality...Credentialing & Peer Review (CPR) Team, the Peer Review Specialist works closely with CPR's Director and Clinical Lead,… more