- Humana (Des Moines, IA)
- **Become a part of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by ... trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced… more
- 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, ... required to achieve that purpose. Job Summary The Manager, Customer Solution Center Appeals and Grievances is responsible for the centralized intake, logging and… 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
- Adecco US, Inc. (Ontario, CA)
- Adecco is assisting a local client recruiting for Clinical Appeals Representative opportunities in Ontario, CA (90% remote). This is an excellent opportunity to ... an impact in the healthcare industry. If a Clinical Appeals Representative role sounds like something you...to: + Serve as point of contact for member grievances and potential quality of care issues + Process… more
- Point32Health (MA)
- …responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for ... + Must be able to organize, plan and implement the functions of Member Appeals and Grievances , maintain timelines and turnaround times to meet multiple… more
- Commonwealth of Pennsylvania (PA)
- Appeals Referee Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5055524) Apply Appeals Referee Salary $77,379.00 - $117,497.00 Annually ... of Labor & Industry is excited to welcome an Appeals Referee to our dedicated team in the Hermitage...the office, as well as resolve any complaints or grievances received. Work also includes a variety of administrative… 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: ol9qxfwb 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
- CVS Health (Salem, OR)
- …claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals . + Initiates out-reach/welcome calls to ensure constituents ... heart, each and every day. **Position Summary:** Health Concierge -Customer Service Representative is the face of Aetna to provide targeted, personalized service… more
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