- Fallon Health (Worcester, MA)
- …regulatory requirements and member and provider expectations. The FH Appeals and Grievances Triage Administrator serves to administer the FH Appeals and Grievance ... responsible for triaging and assigning all incoming appeals and grievances addressed to the Member Appeals & Grievances... grievances addressed to the Member Appeals & Grievances Department and Provider Appeals Department. This position will… 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
- Healthfirst (NY)
- …and Responsibilities:** + Conduct quality audits of A&G items cases grievances , pre-service appeals, and post service appeals utilizing appropriate sources of ... required to complete the audit. + Review and investigate appeals and grievances requests to ensure all requests are identified, classified, and fully resolved… more
- LA Care Health Plan (Los Angeles, CA)
- Appeals & Grievances Regulatory Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This position is responsible for… 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
- Molina Healthcare (New Haven, 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
- Healthfirst (NY)
- + Conduct quality audits of A&G items including grievances , pre-service appeals, and post service appeals utilizing appropriate sources of information; including ... and performance to ensure quality. + Review and investigate appeals and grievances requests to ensure all requests are identified, classified, and fully resolved… more
- Healthfirst (PA)
- …+ Experience in clinical practice with experience in appeals & grievances , claims processing, utilization review or utilization management/case management. + ... Demonstrated understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual, Milliman or Medicare local coverage guidelines + Ability to work independently on several computer applications such as Microsoft Word and Excel, as well as… more
- Humana (Topeka, KS)
- …+ MD or DO degree + A current and unrestricted license in at least one state and willing to obtain license, as required, for various states in region of assignment + ... Board Certified in an approved ABMS Medical Specialty + **Internal Medicine, Family Practice, Geriatrics, Hospitalist, Emergency Medicine, or Physical Medicine and Rehab, Anesthesiology and General Surgery trained** + Excellent written and communication skills… more
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