- Point32Health (MA)
- …partners, colleagues and communities. **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
- Humana (Atlanta, GA)
- …of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties… more
- Fallon Health (Worcester, MA)
- …and appeals , which includes, educating the member and/or member representative about the grievance /appeal, gathering all pertinent and relevant information ... Twitter and LinkedIn. **Brief summary of purpose:** The Fallon Health (FH) Appeals and Grievance process is an essential function to FH compliance with CMS… 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 Appeals & Grievances Location: Los Angeles, CA, US,… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Investigate and resolve medical necessity member appeals . Ensure compliance with state and federal ... Centers for Medicare and Medicaid Services requirements. Maintain all appeals documentation according to external agency requirements. **Supervision Exercised:** +… more
- 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 ... - Customer Experience** analyze and resolve verbal and written appeals from consumers. Respond to requests for information from...maintain good will and cooperation. + Act as a representative at Administrative Hearings conducted via phone or in… more
- CVS Health (Harrisburg, PA)
- …Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. Educates ... do it all with heart, each and every day. **Position Summary** Customer Service Representative is the face of Aetna and impacts members' service experience by manner… more
- BrightSpring Health Services (Louisville, KY)
- …to Member and Provider issues. Refer all unresolved issues to the next level including grievance and appeals . + Actively market plan to new senior care partners ... Our Company Signature Advantage Overview Seeking a Sales Account Representative /Executive for our Signature Advantage Plan who will work with senior care partners to… more
- Highmark Health (Harrisburg, PA)
- …This position is also responsible for assisting members in navigating the grievance and appeals process and representing member interests internally and ... externally. **ESSENTIAL RESPONSIBILITIES** + Communicate effectively with staff, providers and members to accomplish business and member needs + Initiate outreach efforts, primarily by telephone, related to targeted preventive health initiatives: + Perform… more
- Transdev (Readville, MA)
- …+ Research, compile, and prepare data for use in grievance hearings, arbitration proceedings, labor/management initiatives, collective bargaining negotiations, and ... Resources policies and governmental laws and regulations. + Manage the grievance process and provide comprehensive responses to complaints, grievances, and… more
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