- 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, ... call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This… more
- Elevance Health (Tampa, FL)
- **Grievance/ Appeals Analyst Lead** **Candidates must be located within 50 miles an Elevance Health PulsePoint office. This position is primarily work from home ... you to work in the office quarterly.** **Schedule: Monday-Friday 8am-5pm EST** The **Grievance/ Appeals Analyst Lead** is responsible for leading and coaching a… more
- Point32Health (MA)
- …general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance Analyst is responsible per State and Federal regulations ... responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for… more
- Highmark Health (Carson City, NV)
- …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
- CenterLight Health System (NY)
- …efficiency. + Support stakeholders in claims appeals : review and track claims appeals and grievances , prepare reports, and provide status updates to ensure ... JOB PURPOSE: The Claim Analyst will play a pivotal role in enhancing the efficiency and effectiveness of the claims department by evaluating and refining processes,… more
- City of Cincinnati (Cincinnati, OH)
- HUMAN RESOURCES ANALYST (GENERALIST) Print (https://www.governmentjobs.com/careers/cincinnati/jobs/newprint/4932310) Apply HUMAN RESOURCES ANALYST (GENERALIST) ... experience with collective bargaining agreements, corrective action, and grievance and appeals procedures; must be skilled in analyzing and investigating complaints,… more
- Evolent (Lansing, MI)
- …supporting Evolent's clinical services (ie, specialty care, utilization management, care management, appeals & grievances ) + Using analytical tools to integrate ... the mission. Stay for the culture. **What You'll Be Doing:** **Senior Analyst , Operational Analytics** The Operational Performance Analytics team, a part of… more
- CVS Health (Springfield, IL)
- …building. + Coordinate with Network Management to issue provider CAP + Monitor Grievances according NCQA standards categories (3 grievances per QTR), including ... Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards * Excellent analytical… more
- Evolent (Des Moines, IA)
- …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
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