- BroadPath Healthcare Solutions (Tucson, AZ)
- …we are hiring Work from Home Appeals and Grievance Specialists . The Appeals and Grievance Specialist plays a key role in helping members navigate ... and understand their benefits related to Appeals , External Medical Review, and the Fair Hearing process....Helps members understand their rights and responsibilities including the appeals process, External Medical Review and State Fair Hearing… more
- Cognizant (St. Paul, MN)
- …applicant that lives in the United States. Summary: We are seeking a dedicated Provider Appeals & Grievance Specialist with1 to 2 years of experience to ... Provider Appeals & Grievances Specialist (remote) This...and state Medicaid policies. Basic qualifications: 2 years of Appeals and Grievance 1 Year of medical… more
- Molina Healthcare (Akron, OH)
- …claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. Requests and reviews medical records, notes, ... (CMS). Essential Job Duties Facilitates comprehensive research and resolution of appeals , disputes, grievances, and/or complaints from Molina members, providers, and… more
- Molina Healthcare (Grand Rapids, MI)
- …Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and ... to ensure that internal and/or regulatory timelines are met. Research claims appeals and grievances using support systems to determine appeal and grievance… 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
- Molina Healthcare (Bowling Green, KY)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance … 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
