• Member Appeals and Grievance…

    Fallon Health (Worcester, MA)
    …applicable regulatory requirements and member expectations. The FH Member Appeals and Grievance Intake Administrator serves to administer the FH ... Appeals and Grievance process as outlined in the FH ...Coverage, departmental policies and procedures, and regulatory standards. The Member Appeals & Grievances Intake … more
    Fallon Health (08/01/25)
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  • Manager, Customer Solution Center Appeals…

    LA Care Health Plan (Los Angeles, CA)
    …is responsible for the centralized intake , logging and triage process for all member appeals and grievances. The Manager oversees the resolution of member ... the identification, documentation, reporting, investigation and resolution of all member appeals and grievances in a timely...on an annual basis, or as necessary, appeal and grievance policies and procedures, member correspondence, etc.,… more
    LA Care Health Plan (07/08/25)
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  • Appeals Specialist II, (Remote)

    CareFirst (Baltimore, MD)
    …entry and to problem solve any issues regarding the appeal and/or grievance intake /entry process. **QUALIFICATIONS:** **Education Level:** High School Diploma or ... Specialist II will be responsible for the initial analysis of appeals / grievance correspondence, and determination of next steps, with minimal supervision… more
    CareFirst (07/30/25)
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  • Appeals Specialist I (remote)

    CareFirst (Baltimore, MD)
    …data entry and to problem solve any issues regarding the appeal/ grievance intake /entry process. **QUALIFICATIONS:** **Education Level:** High School Diploma ... The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and determination of next steps for Government… more
    CareFirst (07/30/25)
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  • Member Service Rep

    Commonwealth Care Alliance (Boston, MA)
    …appointments, transportation, translation, and interpretation services. * Initiates prior authorization intake process. * Assist in resolving member billing ... documents including provider listings in their areas. * Complete comprehensive appeal and grievance intakes. * Collaborate with the member to accurately document… more
    Commonwealth Care Alliance (07/10/25)
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  • Customer Solution Center Quality Auditor II

    LA Care Health Plan (Los Angeles, CA)
    …and Outreach, Ansafone, Web Inquiries, MRU ( Member Relations Unit), and Appeals and Grievance , performance against key performance indicators and recognizes ... were met across all verticals under CSC. Conducts random member audits and surveys to ensure the member...is also responsible for assisting Call Center with call intake as needed. (10%) Performs other duties as assigned.… more
    LA Care Health Plan (07/11/25)
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