• Specialist , Appeals

    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
    Molina Healthcare (11/23/25)
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  • Customer Solution Center Appeals

    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 (11/06/25)
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  • Customer Solution Center Appeals

    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
    LA Care Health Plan (11/06/25)
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  • Grievances & Appeals

    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
    Modivcare (12/05/25)
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  • Appeals and Grievances Dismissal…

    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
    Healthfirst (12/11/25)
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  • Appeals Specialist I (Remote)

    CareFirst (Baltimore, MD)
    **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and ... and tracking information to facilitate and expedite processing of appeals and/or grievances received from a variety...breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit… more
    CareFirst (12/12/25)
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  • Senior Employee and Labor Relations…

    Tufts Medicine (Boston, MA)
    …research breakthroughs to life. **Job Overview** The Senior Employee & Labor Relations Specialist serves as a trusted subject matter expert and strategic partner to ... role may delegate and oversee the work of the Employee & Labor Relations Specialist . This position requires deep knowledge of both employment and labor laws (eg,… more
    Tufts Medicine (12/15/25)
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  • Human Resources Specialist (LR/ER)

    Washington Headquarters Services (Alexandria, VA)
    …related to: adverse and disciplinary actions associated with conduct, dispute resolution, grievances , Merit Systems Protection Board (MSPB) appeals , or Office of ... Incumbent typical work assignments may include the following: Serving as a senior specialist within the LMER division providing a full range of advisory services,… more
    Washington Headquarters Services (12/09/25)
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  • Records Specialist 1

    Commonwealth of Pennsylvania (PA)
    …Maintains inmate files for compliance with applicable laws and regulations and tracks appeals , misconducts, and grievances in electronic databases and paper case ... Records Specialist 1 Print (https://www.governmentjobs.com/careers/pabureau/jobs/newprint/5165293) Apply  Records Specialist 1 Salary $40,685.00 - $60,714.00… more
    Commonwealth of Pennsylvania (12/15/25)
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  • Senior RN Peer Review Specialist

    Blue Cross Blue Shield of Massachusetts (Boston, MA)
    …healthcare? Bring your true colors to blue. The Role:The Peer Review Specialist is responsible for monitoring the quality of the credentialed practitioner/ ... Credentialing & Peer Review (CPR) Team, the Peer Review Specialist works closely with CPR's Director and Clinical Lead,...subscriber certificates and apply to the investigation of member grievances . + Manage the fair hearing process for cases… more
    Blue Cross Blue Shield of Massachusetts (12/06/25)
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