- Molina Healthcare (NM)
- …(CMS). **Essential Job Duties** * Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, ... to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate appeals… 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 ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I...team to receive, investigate and resolve member and provider complaints and appeals ; escalates complex issues or… 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 ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist ...II will receive, investigate and resolve member and provider complaints and appeals exercising strong independent judgment.… 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 ... risk 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 ... School Diploma or GED from an accredited institution + Work experience with appeals and grievances or healthcare environment + Work experience requiring verbal… more
- City of New York (New York, NY)
- …of Correction ("DOC" or "the Department"); - Investigate serious incidents; - Review grievances from people in custody and staff; - Evaluate the performance of DOC; ... and change. JOB DESCRIPTION The Board seeks a Standards Specialist ("Monitor") with a passion for justice, fairness, and...the Minimum Standards by visiting jails, taking and resolving complaints from staff and people in custody - Examining… more
- Molina Healthcare (NE)
- …to provide quality and cost-effective member care. This position will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with ... The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory… more
- Volunteers of America Los Angeles (Los Angeles, CA)
- …verification and resolution of facts and issues in matters affecting disciplinary actions, grievances , appeals , and complaints , refers complex matters to HR ... HR generalist work with 20+% dedicated time committed to handling employee complaints , grievances , interactive processes, and disciplinary actions. + Familiarity… more
- The Cigna Group (Salem, OR)
- …networks + Complete onsite quality assessments + Respond to provider inquiries, concerns, complaints , appeals and grievances + Provide ongoing product ... procedures to routine instructions that require professional knowledge in specialist areas. Provides standard professional advice and creates initial… more