- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary** Appeals and Grievances Specialist supports the Operations Department and the Appeals and Grievances ... No **Essential Duties & Responsibilities** Processing of Grievances & Appeals : + Responsible for the progress of grievance... Appeals : + Responsible for the progress of grievance and appeal intervention and resolution. + Assure verbal… more
- Elevance Health (San Antonio, TX)
- …and personalized support throughout the consumer's treatment journey. **Title:** Grievance / Appeals Representative II **Location:** TX-SAN ANTONIO, 4751 HAMILTON ... immediate support **Build the Possibilities. Make an extraordinary impact.** The Grievance / Appeals Representative II is responsible for reviewing, analyzing and… more
- Intermountain Health (West Valley City, UT)
- **Job Description:** The RCO Appeals Hearing Specialist is responsible for investigating, coordinating and managing legal insurance cases and represents ... and works closely with Intermountain Health legal team, Physician Advisors, and Appeals RN consultants in their various capacities. Fully remote position! +… more
- Molina Healthcare (New Haven, CT)
- …+ 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
- Commonwealth Care Alliance (Boston, MA)
- …& Responsibilities:** + Conduct monthly case review of a random sample of appeals and grievance cases against previously developed scorecard and Federal and ... 011540 CCA- Appeals & Grievances **Position Summary:** Appeals ...+ Communicate and work collaboratively with AG Representatives, Resolution Specialist and Management to maintain and improve quality of… more
- State of Colorado (Denver, CO)
- …are maintained + shared responsibility for this process to address the client's grievance as the Compliance Specialist + addresses all referred grievances that ... Health Professional III- MHTL Compliance Specialist Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4932074) Apply Health Professional III-… more
- Navy Exchange Services (NEX) (Virginia Beach, VA)
- Title: Labor/Employee Relations Specialist I/ II/ III (Non-competitive Progression) Location: United States-Virginia-Virginia Beach Job Number: 250000Q1 Note: This ... Summary: Under the guidance and supervision of a Labor/Employee Relations Specialist or Labor/Employee Relations Manager, responsible for providing technical support… more
- Sutter Health (Sacramento, CA)
- …**Organization:** SMF-Sutter Med Foundation- Central **Position Overview:** The Grievances & Appeals Specialist RN supports the patient and family experience ... CMS requirements and standards such as performance improvement, patient safety, and grievance management. Local, State and Federal laws / regulations pertaining to… more
- Healthfirst (NY)
- …stakeholders (including, but not limited to Regulatory, Claims Configuration, Provider Ops, Appeals & Grievance , Medical Management, Enrollment & Billing, Sales) ... to identify, scope and accurately implement new benefits, services, or other product changes, update processes and/or edit systems to accommodate regulatory requirements + Assist with ad hoc projects such as focus group studies, process improvement initiatives… more
- City and County of San Francisco (San Francisco, CA)
- …discrimination complaints filed by Airport guests in accordance with federal grievance procedures; serves as a community liaison; evaluates and inspects facilities ... a related field. + Possession of a Certified Access Specialist (CASp) certification in good standing with the California...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… more