- Point32Health (MA)
- …direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible per State and Federal regulations ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
- CVS Health (Columbus, OH)
- …Compliance experience. + 1+ years of External Audit Experience + 1+ years of Grievance and Appeals Experience **Education** + High School Diploma or GED ... matter and independently coaches others on matters regarding complaints and appeals , ensuring compliance with federal and/or state regulations. Ensures compliance… more
- Highmark Health (Harrisburg, PA)
- …of a grievance /appeal; documents, investigates, refers and coordinates grievances and appeals ; initiates a case file for each grievance and appeal; ensures ... Review inquiries to determine if they meet definition of appeal/ grievance . + Request and review all related relevant documentation...+ Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement… more
- CVS Health (Columbus, OH)
- …each and every day. **Position Summary** Research and process grievances and appeals for Dual eligible members and providers. Perform outreach to obtain additional ... **Required Qualifications** + 1 year of experience processing health insurance grievance and appeal cases. **Preferred Qualifications** + 2+ years of experience… more
- CVS Health (Richmond, VA)
- …ongoing provider in-services and provider education. + Participates, when requested, in Grievance and Appeals meetings, and/or assists with tracking and trending ... obtain crucial or required information from Providers, such as HEDIS, Credentialing, Grievance and Appeals , SIU, etc. Coordinates provider status information… more
- City and County of San Francisco (San Francisco, CA)
- …School District, or San Francisco City College, working within the Human Resources Analyst (1241) classification. San Francisco is a vibrant and dynamic city, on the ... of understanding; implements pay provisions of arbitration awards, mediated and grievance settlements; and reviews, analyzes, and processes requests for special pay… more
- Corewell Health (Grand Rapids, MI)
- …or advanced level using Microsoft Office Suite preferred + Previous experience with grievance and appeals processes. Preferred How Corewell Health cares for you ... Essential Functions + Responsible for complex and thorough investigation of appeals , external complaints, and fair hearing reviews including: formulate action plan… more
- City and County of San Francisco (San Francisco, CA)
- …the City in state and federal civil litigation (through trial and appeals ), in administrative proceedings involving labor and employment matters, and provides ... 30 unions that represent City employees, including collective bargaining, labor grievance arbitrations, and defending unfair labor practice and other administrative… more
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