- Health First (Rockledge, FL)
- …**Organization:** **HF Administrative Plan Inc* **Title:** *Health First Health Plans Appeals / Grievance Coordinator * **Location:** *Florida - Brevard ... Success in this position will be based on the individual's ability to effectively research, document, analyze and resolve complaints according to complex and strict rules, while identifying and communicating issues appropriately. *PRIMARY ACCOUNTABILITIES:*… more
- Centene Corporation (Phoenix, AZ)
- …and provider complaints, grievances and appeals + Maintain files on individual appeals and grievances + Coordinate the Grievance and Appeals departments ... High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals , claims or related managed care experience. Strong oral, written,… more
- G-TECH Services, Inc. (Detroit, MI)
- …Multi-task Preferred Skills/Experience - Optional but preferred skills/experience. Include: * Grievance and Appeals experience. * Degree in Healthcare/computer ... Process appeals and grievances, analyze, research, and provide comprehensive...analyzing a claim * Experience in classification between a grievance /appeal/organizational determination. * Letter writing * Basic computer skills.… more
- Baylor Scott & White Health (Temple, TX)
- **JOB SUMMARY** The Appeals and Grievance Coordinator is responsible for intake into the Appeals and Grievances Department, including verbal and written ... complaints, grievances and requests for appeals that involve complex matters submitted by Members and...of all regulatory requirements as they apply to complaint, grievance and appeal processes. + Proficient in Microsoft applications,… more
- University of Utah Health (Salt Lake City, UT)
- …EO/AA_ + Supervise the day-to-day activities of staff who process member and provider Grievance and Appeals . + Monitor and set goals for staff workloads. + ... operated in accordance with applicable law. + Demonstrated understanding of insurance appeals and grievance processes. + Demonstrated experience in improving… more
- Dignity Health (Bakersfield, CA)
- … and Grievances Coordinator is responsible for managing and coordinating the appeals and grievance process within Dignity Health MSO. This role involves ... and grievances. Acting a subject matter expert (SME) the Coordinator will work closely with internal teams and external...corrective actions. - Prepare and submit regular reporting on appeals and grievance activity, trends, and outcomes… more
- Geisinger (Danville, PA)
- Job Summary Provides support in administration of the Appeals and Grievance process. Serves as a liaison between Members and the Plan with appeals regarding ... Health Plan and external entities, communicating with all entities involved throughout the appeals and grievance process. + Maintains strict compliance with all… more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- …medical quality of care and actively participates in the functioning of the plan's grievance and appeals processes. + Along with the nurse supervisor and manager ... URAC, ERISA or state regulations. + Supports training of the nurses and coordinator to improve their knowledge, independence, and understanding. + Serves as medical… more