- Humana (Atlanta, GA)
- **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
- Point32Health (Watertown, 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 Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Investigate and resolve medical necessity member appeals . Ensure compliance with state and federal ... forwards to Medical Director as needed. + Ensures that appeals and grievances are resolved timely to...English **Other:** + The physical demands described here are representative of those that must be met by an… 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
- Fallon Health (Worcester, MA)
- …NCQA standards, other applicable regulatory requirements and member expectations. The FH Member Appeals & Grievances Coordinator serves to administer the FH ... of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Coordinator serves as a liaison between FH… more
- CVS Health (Austin, TX)
- …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
- Independent Health (Buffalo, NY)
- …of appeals /complaints. + Ensure verbal and written responses to complaints/ grievances , appeals and investigations follow regulatory standards. + Provide ... priority. + Monitor daily reports to ensure accuracy and timeliness of complaints/ grievances and appeals . + Assist in continuously developing systems, workflows,… more
- State of Colorado (Denver, CO)
- …employment laws; progressive discipline; records management; recruitment; responding to grievances , appeals , charges of discrimination; reorganization issues; ... state personnel rules, state and federal employment laws; responding to grievances , equal Employment Opportunity Commission (EEOC) claims, appeals , charges… more
- US Marine Corps (Quantico, VA)
- …investigations and leave administration. Performs and reviews trend analysis of grievances , unfair labor practices, complaints, and appeals , and develops ... be considered in effecting disciplinary actions, removals, suspensions, and in resolving grievances and appeals related to formal disciplinary actions taken and… more
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