- Santa Clara Family Health Plan (San Jose, CA)
- …medical records, notice of action, or any other pertinent information related to grievances and appeals from medical groups, delegated entities and/or providers. ... Grievance and Appeals Coordinator Salary Range: $66,273 - $99,409 The...Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or… more
- Santa Clara Family Health Plan (San Jose, CA)
- …timely, professional, and culturally competent manner. Intake, handle and coordinate member grievances , appeals and billing issues, escalating to the Grievance ... Customer Services Representative I (Temporary) Salary Range: $54,647 - $79,237...and Appeals department, when necessary. Educate members and providers on… more
- Central California Alliance for Health (Merced, CA)
- …dissatisfaction with any aspect of the Alliance's health care plan. Expedited Appeals / Grievances : A complaint or Appealinvolving an imminent and serious threat ... specific resolution(s) within regulatory timeframes. Areas of Grievance work include: Appeals : A member complaint involving an adverse benefit determination by an… more
- Northwest Bank (Warren, PA)
- …performing research, investigation, negotiation, and resolution of all types of customer appeals and grievances . Essential Functions * Understand the reasons and ... each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations… more
- Santa Clara Family Health Plan (Gilroy, CA)
- …relevant information to management; make recommendations. Address member questions, concerns, grievances , appeals or requests for services in accordance with ... REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. Associate's… more
- Santa Clara Family Health Plan (San Jose, CA)
- …maintaining regulatory reports related to Case Management, Utilization Management, Claims, Members, Grievances , and Appeals . Business Systems Analyst I - The ... REQUIREMENTS - Required (R) Desired (D) The requirements listed below are representative of the knowledge, skill, and/or ability required or desired. Bachelor's… 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
- Point32Health (Canton, MA)
- …responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for ... (https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance… more
- Healthfirst (FL)
- …outreach through dismissal and complete verbal outreach attempts** + **Analyze incoming appeals and grievances to determine eligibility for dismissal based on ... to the intricate, multi-step details of the Appointment of Representative (AOR) and Waiver of Liability (WOL) processes to...GED from an accredited institution + Work experience with appeals and grievances or healthcare environment +… more
- Robert Half Accountemps (Eden Prairie, MN)
- Description Clinical Appeals Representative (Contract - Fully Remote) We're seeking a detail-oriented Clinical Appeals Representative to join our team on ... health insurance operations by managing documentation, coordinating with providers, and ensuring appeals and grievances are processed accurately and on time.… more
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