- Harbor Health Services, Inc. (Mattapan, MA)
- …process improvement, communication to employees about QI efforts. Working with the Appeals and Grievances Specialist , maintains oversight of the Grievances and ... consistency of decisions. Supervisory responsibilities for UM RN, Quality Analyst, Appeals and Grievances Specialist . Requirements: Bachelor's Degree required,… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and ... breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit...with unit projects and other duties related to the appeals , grievance , and/or reconsideration process. Communicates with… 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 Location: Los ... net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- Molina Healthcare (San Antonio, TX)
- …claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. * Requests and reviews medical records, notes, ... and Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or authorized… more
- Tufts Medicine (Boston, MA)
- …involving a variety of areas including employee discipline/corrective action and employee appeals and the grievance process. 2. Develops and modifies Employee ... research breakthroughs to life. **Job Overview** The Senior Employee & Labor Relations Specialist serves as a trusted subject matter expert and strategic partner to… more
- Washington Headquarters Services (Alexandria, VA)
- …Incumbent typical work assignments may include the following: Serving as a senior specialist within the LMER division providing a full range of advisory services, ... guidance to managers and employees in the administration of the OSW/WHS Grievance System; counseling and advising managers and employees regarding their rights and… more
- Centene Corporation (Tacoma, WA)
- …member and provider material for cultural and linguistic appropriateness. + Monitors grievance and appeals processes for C&L issues. + Proactively identifies ... on workplace flexibility. **Position Purpose:** The Senior Health Equity Specialist is responsible for maintaining compliance with regulations and contractual… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …and Management Team + Legal Department: + Medical Directors + Member Appeals Grievance Programs (Commercial, Medicare Advantage, and InterPlan Program) + ... your true colors to blue. The Role:The Peer Review Specialist is responsible for monitoring the quality of the...Credentialing & Peer Review (CPR) Team, the Peer Review Specialist works closely with CPR's Director and Clinical Lead,… more
- Cedars-Sinai (CA)
- …CSHS employees on company policies and procedures regarding access to care, the grievance and appeals process, the eligibility process, etc. + Remains updated ... **Job Description** The Managed Care Compliance Specialist is responsible for assisting with the implementation...ID** : 11981 **Working Title** : Managed Care Compliance Specialist - Managed Care **Department** : MNS Managed Care… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …referrals generated to care management programs + Provides administrative support to the grievance and appeals process within the + Medical Services department ... Depending on the specific tasks assigned, the Medical Services Coordination Specialist provides administrative support for any of the programs of Utilization… more
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