- Humana (Oklahoma City, OK)
- **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
- AmeriHealth Caritas (Philadelphia, PA)
- …more about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor, Appeals and Grievances , this position is responsible for the ... complaints/issues to management + Monitors to ensure that all problems with appeals / grievances presented by plan members/participants are resolved in accordance… more
- Point32Health (MA)
- …responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for ... + Must be able to organize, plan and implement the functions of Member Appeals and Grievances , maintain timelines and turnaround times to meet multiple… more
- Point32Health (Canton, MA)
- …responsible for the accurate coordination, efficient administration and resolution of member appeals and member grievances submitted by Point32Health members for ... (https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and Grievance… more
- Robert Half Accountemps (Eden Prairie, MN)
- Description Clinical Appeals Representative (Contract - Fully Remote) We're seeking a detail-oriented Clinical Appeals Representative to join our team on ... health insurance operations by managing documentation, coordinating with providers, and ensuring appeals and grievances are processed accurately and on time.… more
- Fallon Health (Worcester, MA)
- …other applicable regulatory requirements and member and provider expectations. The FH Appeals and Grievances Triage Administrator serves to administer the FH ... standards. The Triage Administrator is responsible for triaging and assigning all incoming appeals and grievances addressed to the Member Appeals &… more
- Adecco US, Inc. (Ontario, CA)
- Adecco Medical & Science is hiring a REMOTE Clinical Appeals Representative for a healthcare organization based in Ontario, CA! This is a 100% remote opportunity ... as the point of contact for Health Plan member grievances and potential quality of care issues (PQIs) *...* Coordinate the intake and initial processing of member grievances and quality of care concerns from internal and… more
- MTA (New York, NY)
- …and participate in monthly conferences with union representatives to discuss contract grievances and employee discipline appeals ; perform analytical review of ... Senior Labor Relations Representative Job ID: 12716 Business Unit: MTA Headquarters...Aug 15, 2025 Description JOB TITLE: Senior Labor Relations Representative DEPT/DIV: Labor Relations WORK LOCATION: 420 Lexington Ave… more
- Fallon Health (Worcester, MA)
- …of Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake Administrator is responsible for triaging and ... assigning all incoming appeals and grievances...acknowledgement of the grievance/appeal, educating the member and/or member representative about the grievance/appeal, gathering all pertinent and relevant… more
- State of Colorado (Canon City, CO)
- …hours and pay, creates, schedules, and assigns tasks, and resolves informal grievances according to agency policy while reducing inmate idleness and creating real ... daily monitoring, performance management (planning, reviewing and evaluating), resolving complaints/ grievances at the informal level, responsibility for scheduling and… more