- LA Care Health Plan (Los Angeles, CA)
- …Center Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of… 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
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …process for LDH, while also supporting critical statewide programs including grievances , EEOC matters, Civil Service appeals , ADA accommodations, Affirmative ... for managers, supervisors, and employees to ensure compliance. + Investigates employee grievances , Civil Service appeals , and EEOC complaints; prepares findings… more
- Independent Health (Buffalo, NY)
- …Director. This position will prepare written responses to appeals and complaints/ grievances , establish plans of correction and provide education to members ... responsible for the collection and review of medical records specific to quality complaints/ grievances and appeals as indicated in support of a high performing… more
- Molina Healthcare (OH)
- …Represents Member issues in areas involving member impact and engagement including: Appeals and Grievances , Member Problem Research and Resolution, and the ... of Member Materials. **Knowledge/Skills/Abilities** * Maintains confidential telephone line to provide direct assistance to Members and/or family members who are… more
- LA Care Health Plan (Los Angeles, CA)
- … Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's… more
- Commonwealth of Pennsylvania (PA)
- …Maintains inmate files for compliance with applicable laws and regulations and tracks appeals , misconducts, and grievances in electronic databases and paper case ... Records Specialist 1 - SCI Somerset Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5125931) Apply...Your score is based on the detailed information you provide on your application and in response to the… more
- TEKsystems (Honolulu, HI)
- Description Conducts critical analysis of highly complex and sensitive member and provider appeals , inquiries and grievances and applies internal policies ... and external resources and presents a full explanation of the member's or provider 's position and concerns to management and decision makers. Assists Supervisor and… more
- Commonwealth Care Alliance (Boston, MA)
- …issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and resolve ... Medicare, and commercial payment methodologies and supports audit, compliance, and provider engagement initiatives. This role also provides support in managing … more
- The Cigna Group (Tallahassee, FL)
- …Complete onsite quality assessments + Respond to provider inquiries, concerns, complaints, appeals and grievances + Provide ongoing product education to ... This role delivers professional activities in the Provider Contracting job family. The position is responsible for dental provider recruitment and contracting as… more