- Humana (Sacramento, CA)
- **Become a part of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by ... trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced… more
- LA Care Health Plan (Los Angeles, CA)
- Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical) Job Category: Clinical Department: CSC Appeals & Grievances Location: ... required to achieve that purpose. Job Summary The Manager, Appeals & Grievances (A&G) & General Operations...years of clinical acute care experience with at least 3 years of experience with health care grievance and/or… more
- Evolent (Sacramento, CA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator** **,** ** Appeals and Grievances ** at Evolent will serve as a point of contact ... for processing post determination reviews and appeals requests in accordance with departmental policies, regulatory requirements,...A high school diploma or GED is required. + 3 years of experience in an Intake Coordinator role… more
- Elevance Health (Walnut Creek, CA)
- …HS diploma or GED and a minimum of 3 years experience working in grievances and appeals , claims, or customer service; or any combination of education and ... reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (ie member, provider, regulatory and… more
- Cognizant (Sacramento, CA)
- …any qualified applicant in the United States. **Job Summary:** We are seeking a dedicated Appeals & Grievance Specialist with 2 to 3 years of experience to join ... processes to improve efficiency and patient satisfaction. **Responsibilities:** Reviewing available Appeals & Grievances for the pending claims to verify… more
- The County of Los Angeles (Los Angeles, CA)
- …personnel in their unit and effectively recommending the adjustment of grievances and disciplinary problems. Other positions are assigned such functions as: ... first level technical and administrative supervision to the complaint or advanced-level appeals unit. Essential Job Functions + Supervises the activities of all… more
- LA Care Health Plan (Los Angeles, CA)
- …Training Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... CSC staff on identified areas of improvement, such as Appeals and Grievance processes, Claims, etc. Through various delivery...may be considered. Education Preferred Experience Required: At least 3 years of previous experience as a trainer in… more
- City and County of San Francisco (San Francisco, CA)
- …bargaining agreements. + Key duties include negotiating resolutions to grievances , investigating complaints of serious employee misconduct, and conferring with ... degree from an accredited college or university. Experience: Three ( 3 ) years of verifiable professional human resources experience, similar...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… more
- LA Care Health Plan (Los Angeles, CA)
- …Functional knowledge of Membership Eligibility and Enrollment, Member Maintenance, PCP assignment, Appeals and Grievances preferred. EDI 5 years of EDI Domain ... Portal etc.) from each Domain System * Provide Level 3 Production Support for each Domain System * Drive...IT Vendor (Software and Consultant) Management. Preferred: At least 3 years of Production Support experience. At least … more
- Sacramento County (Sacramento, CA)
- …filing exam. Next filing cut-offs are at 5:00 pm on: 3 /28/2025, 4/25/2025, 5/23/2025, 6/20/2025, 7/25/2025, 8/22/2025, 9/26/2025, 10/24/2025 Nurse Practitioners ... Street, Room 2640, Sacramento, CA 95814, telephone: ###. Such appeals must be filed within thirty (30) calendar days...Pay a fair share fee to the union; or, 3 . Meet specific requirements under which an equivalent amount… more
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