- Molina Healthcare (Dallas, TX)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance… more
- Elevance Health (San Antonio, TX)
- …consultant. + Triages clinical and non-clinical inquiries, grievances and appeals , prepares case files for member grievance committees/hearings. + Summarizes ... now part of CarelonRx (formerly IngenioRx), and a proud member of the Elevance Health family of companies. Together,...limited to: + Conducts investigation and review of customer grievances and appeals involving provision of service… more
- Healthfirst (TX)
- …Contact Center Operations, Claims, DSE, and E&B to resolve member and provider appeals . + Ensures appeals and grievances are categorized and processed ... review. + Notifies team lead of identified patterns of appeals , claim errors, configuration issues or other systemic problems...Acts/Serves as a liaison between the Health Plan and Member , Members Family and Providers during appeal processing and… more
- Molina Healthcare (Austin, TX)
- …for claims payment); Provider/ Member Inquiry Research and Resolution; and Provider/ Member Appeals and Grievances . * Coordinates with Corporate ... hospitals, and other health care providers. * Contributes as a key member of the department's leadership team and participates in committees addressing the… more