• Specialist , Appeals

    Molina Healthcare (Omaha, NE)
    …+ 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
    Molina Healthcare (06/26/25)
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  • Customer Solution Center Appeals

    LA Care Health Plan (Los Angeles, CA)
    Customer Solution Center Appeals and Grievances Specialist II 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 (07/08/25)
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  • Appeals and Grievance Specialist

    Commonwealth Care Alliance (Boston, MA)
    011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and ... as well as externally to facilitate timely resolution of all grievances and appeals and ensures compliance with regulations. Additionally, this position is… more
    Commonwealth Care Alliance (05/21/25)
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  • Appeals and Grievances Program…

    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 (06/06/25)
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  • Appeals and Grievances Coordinator…

    Healthfirst (FL)
    …including Contact Center Operations, Claims, DSE, and E&B to resolve member and provider appeals . + Ensures appeals and grievances are categorized and ... for clinical review. + Notifies team lead of identified patterns of appeals , claim errors, configuration issues or other systemic problems identified during appeal… more
    Healthfirst (07/18/25)
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  • Grievance & Appeals Specialist

    Robert Half Accountemps (Los Angeles, CA)
    …A Medical IPA Group in Los Angeles is in the immediate need of a Grievance & Appeals Specialist . The Grievance & Appeals Specialist , will be in ... with State/Federal laws, rules, and guidelines. The Grievance & Appeals Specialist will be expected to perform...Basic Medical Terminology * Proven track record in handling Appeals and Medical Grievances * Excellent coordination… more
    Robert Half Accountemps (07/20/25)
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  • Benefits Specialist III

    State of Colorado (Denver, CO)
    …employment laws; progressive discipline; records management; recruitment; responding to grievances , appeals , charges of discrimination; reorganization issues; ... state personnel rules, state and federal employment laws; responding to grievances , equal Employment Opportunity Commission (EEOC) claims, appeals , charges… more
    State of Colorado (07/10/25)
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  • Customer Solution Center Audit Readiness…

    LA Care Health Plan (Los Angeles, CA)
    …Center Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: ... call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This… more
    LA Care Health Plan (07/17/25)
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  • Human Resource Specialist (Employee…

    Department of State - Agency Wide (Washington, DC)
    …and management official related to discipline, adverse actions, performance-based actions, grievances , appeals and other third-party actions. There is no ... and management official related to discipline, adverse actions, performance-based actions, grievances , appeals and other third-party actions. There is no… more
    Department of State - Agency Wide (07/11/25)
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  • CDOC - Community Programs Specialist III…

    State of Colorado (Colorado Springs, CO)
    CDOC - Community Programs Specialist III (Re-Entry) - CO Springs Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5011224) Apply  CDOC - ... Community Programs Specialist III (Re-Entry) - CO Springs Salary $4,906.00 - $7,849.00 Monthly Location Colorado Springs, CO Job Type Full Time Job Number PAR 6324… more
    State of Colorado (07/19/25)
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