- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC ... Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist II is...addition, is responsible for review and approval of all member letters prior to issuance. This position facilitates recommendations… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I...members. It will support the Appeals and Grievances team to receive, investigate and resolve member… more
- LA Care Health Plan (Los Angeles, CA)
- …Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider complaints and ... Customer Solution Center Appeals and Grievances Specialist ...experience in Managed Care with specific experience in resolving member and provider complaint and appeals issues,… more
- Molina Healthcare (Atlanta, GA)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance… more
- Molina Healthcare (Austin, TX)
- …and prepare responses to appeals and grievances . + Elevates appropriate appeals to the Appeals Specialist . + Generates and mails denial letters. ... **JOB DESCRIPTION** **Job Summary** Responsible for reviewing and resolving member & provider complaints and communicating resolution to members (or authorized)… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Coordinator I(Temp) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Coordinator I supports the Customer Solution Center … more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA...+ Communicate and work collaboratively with AG Representatives, Resolution Specialist and Management to maintain and improve quality of… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and ... Communicate and work collaboratively with CCA departments to help manage and resolve member appeals and grievances . + Act as a liaison between multiple… more
- Adecco US, Inc. (Ontario, CA)
- … Representative include but are not limited to: + Serve as point of contact for member grievances and potential quality of care issues + Process and document ... Adecco is assisting a local client recruiting for Clinical Appeals Representative opportunities in Ontario, CA (90% remote). This...grievances and requests in healthcare databases + Request medical… more
- Molina Healthcare (Davenport, IA)
- … Member issues in areas involving member impact and engagement including: Appeals and Grievances , Member Problem Research and Resolution, and the ... development/maintenance of Member Materials. **Knowledge/Skills/Abilities** * Serves as an advocate for...subcontractors and enrollees. * Monitors all formal and informal grievances with Grievance personnel to identify trends or problem… more
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