- Commonwealth Care Alliance (Boston, MA)
- …lines or medical setting preferred - Prior experience with service authorizations, grievances and appeals , scheduling medical appointments preferred - Ability to ... members and all those involved in CCA members' care. The Member Service Representative (MSR) is responsible to provide a best-in-class service experience to all… more
- AmeriHealth Caritas (Philadelphia, PA)
- …more about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances , this position is responsible for the ... complaints/issues to management + Monitors to ensure that all problems with appeals / grievances presented by plan members/participants are resolved in accordance… more
- Independent Health (Buffalo, NY)
- …responsible for the collection and review of medical records specific to quality complaints/ grievances and appeals as indicated in support of a high performing ... plan and physician network. The Clinical Reviewer will investigate quality complaints/ grievances and appeals , document research of initial coverage… more
- MTA (New York, NY)
- …and participate in monthly conferences with union representatives to discuss contract grievances and employee discipline appeals ; perform analytical review of ... Senior Labor Relations Representative Job ID: 12716 Business Unit: MTA Headquarters...Aug 15, 2025 Description JOB TITLE: Senior Labor Relations Representative DEPT/DIV: Labor Relations WORK LOCATION: 420 Lexington Ave… more
- Access Dubuque (Dubuque, IA)
- …to internal processing guidelines. + Assist in review and resolution of complaints, appeals and grievances as needed. + Complete all additional assigned projects ... Member Services Representative **Medical Associates** 1 Positions ID: o6fSxfwu Posted...Health Plans is looking for a **full-time Member Services Representative ** to join our team! **Who You Are:** +… more
- Fallon Health (Worcester, MA)
- …of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and ... assigning all incoming appeals and grievances...acknowledgement of the grievance/appeal, educating the member and/or member representative about the grievance/appeal, gathering all pertinent and relevant… more
- Humana (Tallahassee, FL)
- …Providers / Specialists, benefit coverages, authorizations, Provider claims inquiries, grievances and appeals , transportation needs, and pharmacy support. ... APPLICATION (PDF OR WORD FORMAT) As a Contact Center Representative 2, you will provide coverage for **Eastern Time...120 days of employment as an Inbound Contact Center Representative constitute an appraisal period. This Appraisal Period is… more
- Commonwealth Care Alliance (Boston, MA)
- …lines or medical setting preferred * Prior experience with service authorizations, grievances and appeals , scheduling medical appointments preferred * Ability to ... members and all those involved in CCA members' care. The Member Service Representative (MSR) is responsible to provide a best-in-class service experience to all… more
- State of Colorado (Limon, CO)
- …plans, and conducts performance evaluations; resolves informal staff and/or inmate grievances . Assigns tasks, monitors and inspects work progress and ensures ... pay, creates schedule and assigns tasks and resolves informal grievances according to agency policy; reduces inmate idleness and...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
- State of Colorado (Golden, CO)
- …development training (as available) + Resolves informal staff grievances . Provide formal/informal performance feedback. Initiate progressive discipline, in ... for all youth + Responds to and resolves youth grievances + Act as first public contact with agency...the official appeal form, signed by you or your representative . This form must be delivered to the State… more
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