- Molina Healthcare (New Haven, CT)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. +… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to learn the specialty… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (ALD) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- LA Care Health Plan (Los Angeles, CA)
- Appeals & Grievances Regulatory Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This… 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
- Intermountain Health (West Valley City, UT)
- **Job Description:** The RCO Appeals Hearing Specialist is responsible for investigating, coordinating and managing legal insurance cases and represents ... Intermountain Health in OIG hearings and 1st level grievances with insurance companies and CMS. This position communicates regularly with various levels of internal… more
- Elevance Health (San Antonio, TX)
- …but are not limited to: + Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues. ... medical staff or outside consultant. + Triages clinical and non-clinical inquiries, grievances and appeals , prepares case files for member grievance… more
- State of Colorado (Denver, CO)
- …responsibility for this process to address the client's grievance as the Compliance Specialist + addresses all referred grievances that are unresolved at the ... Health Professional III- MHTL Compliance Specialist Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4932074) Apply Health Professional III-… more
- State of Colorado (Denver, CO)
- …and guidance on issues that relate to performance management, progressive discipline, employee grievances and appeals , and civil rights. You will also be the ... Employee Relations Specialist & ADA Program Administrator (HR Spec IV)...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Mohegan Sun (Uncasville, CT)
- …This position clarifies company policies and procedures, investigates employee grievances and assists management in the proper interpretation and consistent ... employee performance improvement plans + Investigates and documents employee complaints and grievances to ensure compliance and a fair resolution + Assists in… more