- Molina Healthcare (WI)
- **JOB DESCRIPTION** **Job Summary** Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or ... and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I primary function is to...outcomes for members. It will support the Appeals and Grievances team to receive, investigate and resolve member… more
- LA Care Health Plan (Los Angeles, CA)
- …Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider complaints ... Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer...of complaints in compliance with Centers for Medicare and Medicaid Services (CMS), California Department of Health Care Services… more
- Molina Healthcare (Austin, TX)
- …appeals and grievances . + Elevates appropriate appeals to the Appeals Specialist . + Generates and mails denial letters. + Assists with interdepartmental issues ... **JOB DESCRIPTION** **Job Summary** Responsible for reviewing and resolving member & provider complaints and communicating resolution to members (or authorized)… more
- Commonwealth Care Alliance (Boston, MA)
- …The Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare, and commercial payment methodologies and supports audit, compliance, and ... closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and resolve reimbursement concerns.… more
- Molina Healthcare (Davenport, IA)
- …and member retention. Represents Member issues in areas involving member impact and engagement including: Appeals and Grievances , Member Problem ... Research and Resolution, and the development/maintenance of Member Materials. **Knowledge/Skills/Abilities** * Serves as an advocate for members to resolve issues… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... achieve that purpose. Job Summary The Customer Solution Center (CSC) Audit Readiness Specialist II is responsible for the execution, oversight, and monitoring of the… more
- Healthfirst (FL)
- …or a related field preferred. + 2+ years of experience in managed care, member services, or healthcare grievances or complaints resolution. + Working knowledge ... **Key Responsibilities:** + Independently manage a caseload of grievances through the full case lifecycle, from written acknowledgement to investigation, resolution,… more
- Dana-Farber Cancer Institute (Boston, MA)
- …Reporting to the Director of Patient/Family Relations, the Patient / Family Relations (P/FR) Specialist serves as an integral member of the Quality and Patient ... to ensure personalization and humanization of the hospital experience. The P/FR Specialist will support the Patient / Family Relations program at the Institute,… more
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