- Banner Health (AZ)
- … care and accessibility concerns and inquiries on the various levels of the grievance and appeals process. CORE FUNCTIONS 1. Determines which claim disputes meet ... Pay Transparency Rules. Great careers are built at Banner Health . We're looking for the best and brightest to... grievance and appeal issues. 7. Reports at Grievance / Appeals meetings, as appropriate, all incoming, attended… more
- CVS Health (CT)
- …**Preferred Qualifications** * Medical Management - Medicare Complaints, Grievance & Appeals experience. * Health Plan Experience Highly Preferred ... At CVS Health , we're building a world of health ...of this Medical Director role are related to Medicare Appeals :** * Direct daily work on part C appeals… more
- Elevance Health (Atlanta, GA)
- …thresholds within budgetary guidelines. + Monitors trends and analyzes grievance and appeals data to identify and recommend plan and policy changes and to ... , manages inventory and production levels, and operational and plan risk, ensures quality, and regulatory compliance.** PRIMARY DUTIES:...Requirements:** Bachelor's degree and a minimum of 5+ years grievance & appeals experience and a minimum… more
- TEKsystems (Long Beach, CA)
- …reside in CA, AZ, TX, NM, or NV JOB PURPOSE: Facilitates the member grievance and appeal process by investigating, documenting and preparing case files to meet all ... regulatory requirements. ESSENTIAL JOB RESULTS: Investigates member grievance and appeal by gathering supporting documentation from internal departments, contracted… more
- Actalent (Dallas, TX)
- …Diploma or equivalent + Experience: Minimum 2 years in managed care (call center, appeals , or claims) + Experience in health claims processing, coordination of ... Job Title: Specialist, Appeals & GrievancesJob Summary: Responsible for reviewing and...to change and may be subject to specific elections, plan , or program terms. If eligible, the benefits available… more
- BayCare Health System (Clearwater, FL)
- …be working remotely?** Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Grievance Specialist- Health Plan **Location** Clearwater:Park Place ... + Triage, plan , and execute intake of Appeals and Grievance submissions. + Keeping track...deep understanding of gap closure specifications. + Knowledge of health plan operations, benefit coverage, and claims… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …+ Preferred experience in a Third-Party Administrator (TPA) setting About At Brighton Health Plan Solutions, LLC, our people are committed to the improvement ... including URAC, NCQA, and ERISA + Proficiency in Clinical Appeals , Utilization Review, and Grievance processes including...self to work with all your unique abilities. Brighton Health Plan Solutions partners with self-insured employers,… more
- LA Care Health Plan (Los Angeles, CA)
- …6 years of clinical acute care experience with at least 3 years of experience with health care grievance and/or appeals issues, preferably in a managed care ... be willing to relocate Established in 1997, LA Care Health Plan is an independent public agency...and execute on strategic opportunities to improve the overall appeals & grievance process. Create a best… more
- Sanford Health (Sioux Falls, SD)
- …related field required. Master's degree preferred. Minimum of 7 years of experience in health plan appeals and grievances, regulatory oversight, or health ... a drug screen and pre-employment background screening as a condition of employment. **Req Number:** R-0237044 **Job Function:** Health Plan **Featured:** No more
- AmeriHealth Caritas (Philadelphia, PA)
- …of medical management authorizations.; + Research and Investigate member and/or provider appeals and grievance requests, including review of UM/claim denial ... management + Monitors to ensure that all problems with appeals /grievances presented by plan members/participants are resolved...Care environment + 1 to 3 years' experience in grievance / appeals environment required **The Ideal Person will… more