- Elevance Health (Los Angeles, CA)
- **Title: Grievance / Appeals Analyst I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... for employment, unless an accommodation is granted as required by law._ The ** Grievance / Appeals Analyst I** is an entry level position in the Enterprise … more
- Centene Corporation (Phoenix, AZ)
- …member and provider complaints, grievances and appeals + Maintain files on individual appeals and grievances + May coordinate the Grievance and Appeals ... High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals , claims, related managed care experience, or… more
- Centene Corporation (Pittsburgh, PA)
- …annual, and ad-hoc audits. + Manage daily entries into the DBHS Office of Grievance and Appeals database. + Coordinate with all relevant departments, as ... Responsible for reviewing, investigating and tracking member grievances and appeals , and provider claims disputes. Responsible for coordinating as necessary… more
- Cognizant (Boston, MA)
- ** Appeals & Grievance Specialist (remote)** This is a remote position open to any qualified applicant in the United States. **Job Summary:** We are seeking a ... dedicated Appeals & Grievance Specialist with 2 to 3 years of experience to join our team. The ideal candidate will have strong technical skills in MS Excel and… more
- Commonwealth Care Alliance (Boston, MA)
- …**Supervision Exercised:** No **Essential Duties & Responsibilities** Processing of Grievances & Appeals : + Responsible for the progress of grievance and appeal ... pharmacy, dental, reporting, and member services. + Supports the Senior Appeals & Grievance Coordinator and A/G Coordinator in day-to-day tasks and assignments.… more
- Point32Health (MA)
- …Point32Health (https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
- AmeriHealth Caritas (Philadelphia, PA)
- …of medical management authorizations.; + Research and Investigate member and/or provider appeals and grievance requests, including review of UM/claim denial ... in a Managed Care environment + 1 to 3 years' experience in grievance / appeals environment required **The Ideal Person will have:** + Proven experience as a… more
- CVS Health (Hartford, CT)
- …AOA Recognized Specialty **Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. * Health Plan Experience Highly ... of this Medical Director role are related to Medicare Appeals . * Direct daily work on part C ...Appeals . * Direct daily work on part C appeals (both provider and member/nonparticipating providers) * Provide direct… more
- LA Care Health Plan (Los Angeles, CA)
- …Required: At least 5 years of experience resolving health care eligibility, access, grievance and appeals issues, preferably in health services, legal services ... Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC...Coordinates, tracks, and resolves internal and external appeal and grievance complaints for LA Care Plan Partners, including identifying… more
- LA Care Health Plan (Los Angeles, CA)
- …consistent and accurate manner. This position will focus on quality review of non-clinical grievance and appeals cases for all line of business (LOB) to identify ... and evaluation by the Management Team. Duties Focus on quality review of grievance and appeals cases for all LOB to identify areas of improvement to assist the… more
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