- Robert Half Accountemps (Los Angeles, CA)
- Description A Medical IPA Group in Los Angeles is in the immediate need of a Grievance & Appeals Specialist . The Grievance & Appeals Specialist , ... denied claims, complying with State/Federal laws, rules, and guidelines. The Grievance & Appeals Specialist will be expected to perform research and… more
- 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
- TEKsystems (Baltimore, MD)
- … background ! Description Job Profile Summary: The Grievance and Appeal Intake Specialist supports the Appeals and Grievance (A&G) function by handling ... TekSystems is currently hiring for a FULLY REMOTE Grievance and Appeal Intake Specialist ! This...Work involves a review of recorded calls relating to appeals and grievances and prepares written transcripts, as appropriate.… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Quality Auditing Specialist II Job Category: Accounting/Finance Department: CSC Appeals & Grievances ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Quality Auditing (QA) Specialist ...This position will focus on quality review of non-clinical grievance and appeals cases for all line… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, ... 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 (Omaha, NE)
- …hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** **Job Summary** Responsible for reviewing and resolving member ... appeals and communicating resolution to members and provider (or...and grievances using support systems to determine appeal and grievance outcomes. + Requests and reviews medical records, notes,… more
- LA Care Health Plan (Los Angeles, CA)
- … Appeals and Grievances Coordinator I supports the Customer Solution Center Appeals & Grievance Specialists by handling the administrative functions of the ... required by clinical staff to render decisions, assists the Customer Solution Center Appeals & Grievance Manager and Director in meeting regulatory timelines by… 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
- Department of State - Agency Wide (Washington, DC)
- …applicants who respond to this flyer. Responsibilities As a Human Resource Specialist (Employee Relations) at a minimum you will ensure the effective administration ... approach to reported misconduct. Reviews grievances in accordance with the administrative grievance policy and determines whether or not the grievance meets… more
- Department of State - Agency Wide (Washington, DC)
- …applicants who respond to this flyer. Responsibilities As a Human Resource Specialist (Employee Relations) at a minimum you will ensure the effective administration ... approach to reported misconduct. Reviews grievances in accordance with the administrative grievance policy and determines whether or not the grievance meets… more
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