- Point32Health (Watertown, MA)
- …the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst is responsible per State and Federal regulations for ... responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for… more
- Highmark Health (Harrisburg, PA)
- …they meet the definition of a grievance/appeal; documents, investigates, refers and coordinates grievances and appeals ; initiates a case file for each grievance ... parties. + Participate in workgroup meetings to address trends in appeals and grievances and to work on process improvement initiatives with cross functional… more
- City and County of San Francisco (San Francisco, CA)
- …bargaining agreements. + Key duties include negotiating resolutions to grievances , investigating complaints of serious employee misconduct, and conferring with ... professional human resources experience, similar to 1241 Human Resources Analyst , in one or more of the following areas...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… 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 ... boards and commissions and in meetings with other departments. 7. Responds to appeals or protests of human resources decisions and/or procedures; and prepares and… more
- City and County of San Francisco (San Francisco, CA)
- …or San Francisco City College, working within the 1244 Senior Human Resources Analyst classification. ABOUT THE CITY AND COUNTY OF SAN FRANCISCO: San Francisco is ... also in shaping the future of San Francisco. 1244 SENIOR HUMAN RESOURCES ANALYST (E10150) RECRUITMENT + Application Opening: July 14, 2025 + Application Deadline:… more
- CVS Health (Richmond, VA)
- …with heart, each and every day. **Position Summary** The Senior Network Relations Analyst is responsible for the accurate and timely validation and maintenance of ... responsible for reviewing claims data and information. The Senior Network Relations Analyst is responsible for monthly Access and Availability monitoring as required… more
- Insight Global (Lyndhurst, OH)
- …(Enrollment, Encounters, Prior Auths, Eligibility, Claim Submission, Adjudication, Payment, Appeals / Grievances etc) Domain knowledge of CMS (Medicare/Medicare) ... and features to be passed off to a systems analyst who will write the user stories for the...its pieces and parts. Other Responsibilities include: The Business Analyst III is responsible for understanding the stakeholders business… more
- Elevance Health (Richmond, VA)
- …to manage Claim Payment Appeal escalations and may serve as a liaison between grievances & appeals and /or medical management, legal, service operations and/or ... **Provider Payment Appeal Analyst II** **Location:** This role enables associates to...am - 6 pm EST The **Provider Payment Appeal Analyst II** is responsible for supporting the Payment Dispute… more
- Evolent (Tallahassee, FL)
- …supporting Evolent's clinical services (ie, specialty care, utilization management, care management, appeals & grievances ) + Using analytical tools to integrate ... Evolent for the mission. Stay for the culture. **What You'll Be Doing:** ** Analyst , Client Analytics** Integrate and analyze claims and enrollment data from multiple… more
- LA Care Health Plan (Los Angeles, CA)
- …Solution Center Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position ... call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This… more