- Molina Healthcare (San Antonio, TX)
- …for leading, organizing and directing the activities of the Grievance and Appeals Unit that is responsible for reviewing and resolving member complaints and ... * Leads, organizes, and directs the activities of the Appeals & Grievances unit that is responsible for reviewing...monitoring and training of local plans' provider dispute and appeals units to ensure adherence with Medicare standards and… more
- Sharp HealthCare (San Diego, CA)
- …Will Do** Responsible for the investigation, documentation and resolution of member appeals and grievances in compliance with State law, rules, and guidelines; ... Chief Medical Officer (CMO) who is responsible for all decisions regarding clinical appeals and grievances and the Chief Operations Officer (COO) who is responsible… more
- Sharp HealthCare (San Diego, CA)
- …Do** Responsible for the investigation, documentation and resolution of Commercial member appeals and grievances in compliance with State law, rules, and guidelines; ... Chief Medical Officer (CMO) who is responsible for all decisions regarding clinical appeals and grievances and the Chief Operations Officer (COO) who is responsible… more
- Elevance Health (Durham, NC)
- **Manager II Grievance/ Appeals ** **- Claims Support** **Office Locations:** _The selected candidate must reside within a reasonable commuting distance of the ... an accommodation is granted as required by law._ The **Manager II Grievance/ Appeals ** responsible for management oversight of grievances and appeals departmental… more
- Actalent (Boston, MA)
- …Review Clinician Job Description As a Clinical Review Clinician specializing in appeals , you will be responsible for preparing case reviews for Medical Directors ... by thoroughly researching appeals , reviewing applicable criteria, and analyzing the basis for...You will ensure timely review, processing, and response to appeals in accordance with State, Federal, and NCQA standards.… more
- Molina Healthcare (St. Petersburg, FL)
- …leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for reviewing and resolving member and provider ... complaints, appeals , and claim disputes, and communicating resolution to members,...direct oversight, monitoring and training of provider disputes and appeals to ensure adherence with Medicare standards and requirements… more
- CVS Health (Dover, DE)
- …Summary** Responsible for Oversight of that that investigates and resolution of appeals scenarios for all products, which may contain multiple issues and, may ... responses from multiple business units. Ensure timely, customer focused response to appeals . Identify trends and emerging issues and report and recommend solutions.… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances team ... well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is responsible… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Coordinator I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Coordinator I supports the Customer Solution Center Appeals … more
- MTA (Brooklyn, NY)
- Assistant General Counsel III - Appeals , Torts Job ID: 12066 Business Unit: New York City Transit Location: Brooklyn, NY, United States Regular/Temporary: Regular ... 2025 Description Job Information Assistant General Counsel III - Appeals , Torts First Date of Posting: 7/10/2025 Last Date...Torts Reports to: Deputy Executive Assistant General Counsel - Appeals Work Location: 130 Livingston St. Brooklyn Hours of… more
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