- Elevance Health (Durham, NC)
- **Manager II Grievance /Appeals** **- Claims Support** **Office Locations:** _The selected candidate must reside within a reasonable commuting distance of the ... accommodation is granted as required by law._ The **Manager II Grievance /Appeals** responsible for management oversight of grievances and appeals departmental units… more
- Point32Health (MA)
- …communities. **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible ... and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works collaboratively with… more
- Commonwealth Care Alliance (Boston, MA)
- …Processing of Grievances & Appeals: + Responsible for the progress of grievance and appeal intervention and resolution. + Assure verbal and written responses ... verbal and written correspondence. + Thoroughly document all member appeal and grievance related interactions and interventions into CCA database. Member Outreach: +… more
- CoreCivic (Leavenworth, KS)
- …and a responsibility to better the public good. We are currently seeking a ** Grievance Coordinator** who has a passion for providing the highest quality care in an ... to making an impact for the people and communities we serve. The Grievance Coordinator oversees the inmate/resident grievance process and ensures that both… more
- Fallon Health (Worcester, MA)
- …and LinkedIn. **Brief summary of purpose:** The Fallon Health (FH) Appeals and Grievance process is an essential function to FH compliance with CMS regulations, NCQA ... Appeals & Grievances Coordinator serves to administer the FH Appeals and Grievance process as outlined in the Member Handbook/Evidence of Coverage, departmental… more
- CVS Health (Baton Rouge, LA)
- …units. Ensure timely, customer focused response to appeals, complaints and grievance . Responsible for day-to-day implementation of Aetna's appeals, complaints and ... including but not limited to: -Research incoming electronic appeals, complaints and grievance to identify if appropriate for unit based upon published business… more
- Centene Corporation (Sacramento, CA)
- …Maintain files on individual appeals and grievances + May coordinate the Grievance and Appeals Committee + Support the pay-for-performance programs, including data ... High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals, claims or related managed care experience. Strong oral,… more
- Humana (Atlanta, GA)
- …comprehensive analytic review of clinical documentation to determine if an a grievance , appeal or further request is warranted and then delivers final determination ... inbound call center or related customer service experience + Prior grievance and appeals experience + Previous experience processing medical authorizations +… more
- Centene Corporation (Austin, TX)
- …grievances from a clinical perspective. Ensure that the clinical Appeals and Grievance department processes all cases in accordance with policies and procedures + ... in Nursing preferred. 3+ years of combined nursing and appeal and grievance , or utilization management or case management experience. Previous supervisory experience… more
- Centene Corporation (Phoenix, AZ)
- …Maintain files on individual appeals and grievances + May coordinate the Grievance and Appeals Committee + Support the pay-for-performance programs, including data ... High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals, claims or related managed care experience. Strong oral,… more
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