• Grievance & Appeals…

    Robert Half Accountemps (Los Angeles, CA)
    Description A Medical IPA Group in Los Angeles is in the immediate need of a Grievance & Appeals Specialist . The Grievance & Appeals Specialist , ... denied claims, complying with State/Federal laws, rules, and guidelines. The Grievance & Appeals Specialist will be expected to perform research and… more
    Robert Half Accountemps (07/20/25)
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  • Appeals and Grievance…

    Commonwealth Care Alliance (Boston, MA)
    011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances ... No **Essential Duties & Responsibilities** Processing of Grievances & Appeals : + Responsible for the progress of grievance... Appeals : + Responsible for the progress of grievance and appeal intervention and resolution. + Assure verbal… more
    Commonwealth Care Alliance (05/21/25)
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  • Appeals Specialist I (remote)

    CareFirst (Baltimore, MD)
    **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and ... breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit...environment **Preferred Qualifications** + Previous experience working in an appeals and grievance department in a health… more
    CareFirst (07/30/25)
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  • Appeals Specialist II, (Remote)

    CareFirst (Baltimore, MD)
    **Resp & Qualifications** **PURPOSE:** The Appeals Specialist II will be responsible for the initial analysis of appeals / grievance correspondence, and ... care, health care or insurance payor environment. 2 years' experience in Appeals and Grievance Management. **Preferred Qualifications** + Previous experience… more
    CareFirst (07/30/25)
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  • Customer Solution Center Appeals…

    LA Care Health Plan (Los Angeles, CA)
    Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
    LA Care Health Plan (07/08/25)
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  • Specialist , Appeals & Grievances…

    Molina Healthcare (Omaha, NE)
    …hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing and resolving member ... appeals and communicating resolution to members and provider (or...and grievances using support systems to determine appeal and grievance outcomes. + Requests and reviews medical records, notes,… more
    Molina Healthcare (06/26/25)
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  • Appeals and Grievances Program Advisor

    Commonwealth Care Alliance (Boston, MA)
    …& Responsibilities:** + Conduct monthly case review of a random sample of appeals and grievance cases against previously developed scorecard and Federal and ... 011540 CCA- Appeals & Grievances **Position Summary:** Appeals ...+ Communicate and work collaboratively with AG Representatives, Resolution Specialist and Management to maintain and improve quality of… more
    Commonwealth Care Alliance (06/06/25)
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  • Disability/Elder Benefit Specialist (HHS)

    Walworth County (Elkhorn, WI)
    Disability/Elder Benefit Specialist (HHS) Print (https://www.governmentjobs.com/careers/walworthco/jobs/newprint/5021485) Apply  Disability/Elder Benefit ... or community Provide information on consumer rights, complaints, grievances and appeals processes and assistance in preparing and filing complaints, grievances and… more
    Walworth County (07/25/25)
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  • Human Resources Specialist (Employee…

    Defense Logistics Agency (New Cumberland, PA)
    …to Fed civilian employees, eg discipline, grievances, appeals , complaints, communications, employee/supervisory relationships, and rights/obligations. Counsels ... Conditions of Employment Qualifications To qualify for a Human Resources Specialist (Employee Relations & Labor Relations), your resume and supporting documentation… more
    Defense Logistics Agency (07/31/25)
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  • Sr Specialist , Member Engagement (Remote)

    Molina Healthcare (AZ)
    …Member issues in areas involving member impact and engagement including: Appeals and Grievances, Member Problem Research and Resolution, and the ... subcontractors and enrollees. * Monitors all formal and informal grievances with Grievance personnel to identify trends or problem areas of access and care… more
    Molina Healthcare (08/02/25)
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