- Conduent (East Hartford, CT)
- …be part of a culture where individuality is noticed and valued every day. ** Appeals Coordinator - Customer Experience Associate IV** **Summary:** As an ** ... Appeals Coordinator - Customer Experience** analyze and resolve verbal and written appeals from consumers. Respond to requests for information from Department… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Coordinator I (Temporary) Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & ... to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Coordinator I supports the Customer Solution Center Appeals &… more
- Trinity Health (Columbus, OH)
- …financial analysis, audit, provider relations and more. **Position Purpose:** The Appeals and Grievance Coordinator is responsible for the processing and ... resolution of appeals , grievances and disputes from members and providers **What...review with clinical colleagues. + Screen all incoming grievances, appeals and provider claim dispute to ensure they are… more
- Centene Corporation (Salem, OR)
- …workplace flexibility. **Position Purpose:** Act as the liaison for all statewide appeals , fair hearings, review organizations, and other external type appeals . ... NCQA requirements. **(PST preferred).** + Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of… more
- Centene Corporation (Sacramento, CA)
- …**Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. ... verbal and written member and provider complaints, grievances and appeals + Prepare response letters for member and provider...response letters for member and provider complaints, grievances and appeals + Maintain files on individual appeals … more
- Centene Corporation (Phoenix, AZ)
- …**Position Purpose:** Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members. ... verbal and written member and provider complaints, grievances and appeals + Prepare response letters for member and provider...response letters for member and provider complaints, grievances and appeals + Maintain files on individual appeals … more
- Commonwealth Care Alliance (Boston, MA)
- …clinical, operations, pharmacy, dental, reporting, and member services. + Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in ... 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances team… more
- Healthfirst (AL)
- …for clinical review. + Notifies team lead of identified patterns of appeals , claim errors, configuration issues or other systemic problems identified during appeal ... Operations, Claims, DSE, and E&B to resolve member and provider appeals . + Ensures appeals and grievances are categorized and processed within New York state… more
- Fallon Health (Worcester, MA)
- …NCQA standards, other applicable regulatory requirements and member expectations. The FH Member Appeals & Grievances Coordinator serves to administer the FH ... departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Coordinator serves as a liaison between FH members and FH… more
- CUNY (New York, NY)
- …action efforts, including the Annual Affirmative Action Plan; + As 504/ADA Coordinator , review appeals of reasonable accommodation request decisions; + ... to improve services; + Conducting fact-finding investigations, including as Title IX coordinator , that ensure due process for all parties in response to complaints… more
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