- LA Care Health Plan (Los Angeles, CA)
- Manager, Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and triage process for… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to learn the...function is to learn the specialty level appeals and grievances work supporting the higher level position in this… more
- Trinity Health (Columbus, OH)
- …and Grievance Coordinator is responsible for the processing and resolution of appeals, grievances and disputes from members and providers **What You Will Do:** + ... Document all appeal requests or grievances upon receipt in the operating systems and routes...and review with clinical colleagues. + Screen all incoming grievances , appeals and provider claim dispute to ensure they… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA-Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the Appeals ... and Grievances department through many NCQA and other related quality...+ Associate's Degree or equivalent experience in Appeals and Grievances **Desired Education:** + Bachelor's Degree (BS or BA)… more
- Point32Health (Watertown, MA)
- …coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for all lines of business. **Job ... organize, plan and implement the functions of Member Appeals and Grievances , maintain timelines and turnaround times to meet multiple requirements/regulations… more
- Molina Healthcare (Waterbury, CT)
- …for the comprehensive research and resolution of the appeals, dispute, grievances , and/or complaints from Molina members, providers and related outside agencies ... internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. + Requests… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider… 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 & ... Grievances Location: Los Angeles, CA, US, 90017 Position Type:...purpose. Job Summary The Customer Solution Center Appeals and Grievances Coordinator I supports the Customer Solution Center Appeals… more
- UPMC (Pittsburgh, PA)
- …a board-certified physician with a Pennsylvania Medical License for a Medical Director, Grievances role with UPMC Community Health Choices. This role is fully remote ... weekly availability within the aforementioned time frame. The Medical Director, Grievances is responsible for assuring physician commitment and delivery of… more
- Humana (Little Rock, AR)
- …+ MD or DO degree + A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of ... assignment + Board Certified in an approved ABMS Medical Specialty + Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be… more
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