- Universal Health Services, Inc. (Reno, NV)
- …at: Job Summary: Under the direction of the Manager of Operations, the Appeals Specialist is responsible for ensuring the appropriate review, research, ... processing and responding to written member and provider complaints, appeals , and grievances . This position is required to apply analytical and critical thinking… more
- Santa Clara Family Health Plan (San Jose, CA)
- …essential duty listed below satisfactorily. Act as a back-up to the Grievance and Appeals Intake Specialist during times of high volume work and/or staffing ... medical records, notice of action, or any other pertinent information related to grievances and appeals from medical groups, delegated entities and/or providers.… more
- Harbor Health Services, Inc. (Mattapan, MA)
- …key process improvement, communication to employees about QI efforts. Working with the Appeals and Grievances Specialist , maintains oversight of the ... and consistency of decisions. Supervisory responsibilities for UM RN, Quality Analyst, Appeals and Grievances Specialist . Requirements: Bachelor's Degree… more
- San Francisco Health Plan (San Francisco, CA)
- …quality review functions, ensuring timely and compliant resolution of clinical grievances , appeals , potential quality issues (PQIs), provider dispute ... WILL DO: Provide subject matter expertise and high-level oversight of clinical grievances and appeals , PQIs, provider dispute resolutions, corrective action… more
- Johns Hopkins University (Baltimore, MD)
- …Record Keeping Maintain the ERLR database that includes disciplinary actions, appeals , grievances , risk assessments, RFI's, and policy violations. Updates ... PHR or SPHR certification preferred. Classified Title: Labor Relations Specialist Role/Level/Range: ATP/04/PD Starting Salary Range: $62,900 - $110,100 Annually… more
- Molina Healthcare (San Antonio, TX)
- …**Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals and… 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 ... 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 (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- Modivcare (Ridgeland, MS)
- …this opportunity may be the right fit for you! Modivcare is looking for an experienced Grievances & Appeals Specialist to join our team! This position is ... for service failure. This role + Handles high-risk member complaints and grievances . + Collects all necessary supporting information to accurately provide a… more
- Healthfirst (FL)
- …outreach through dismissal and complete verbal outreach attempts** + **Analyze incoming appeals and grievances to determine eligibility for dismissal based on ... or GED from an accredited institution + Work experience with appeals and grievances or healthcare environment + Work experience requiring verbal and written… more
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