- Molina Healthcare (Albuquerque, NM)
- …+ Responsible for the comprehensive research and resolution of the appeals , dispute, grievances , and/or complaints from Molina members, providers ... that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. +… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve… more
- LA Care Health Plan (Los Angeles, CA)
- Appeals & Grievances Regulatory Audit Readiness Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los ... call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances across all lines of business). This… more
- Commonwealth Care Alliance (Boston, MA)
- 011540 CCA- Appeals & Grievances **Position Summary:** Appeals and Grievances Program Advisor monitors and supports the operations and compliance of the ... Appeals and Grievances department through many NCQA...+ Communicate and work collaboratively with AG Representatives, Resolution Specialist and Management to maintain and improve quality of… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances , appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare ... each grievance or appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with… more
- Robert Half Accountemps (Los Angeles, CA)
- …Medical IPA Company in Mid-Wilshire is seeking a dedicated and detail-oriented Grievance and Appeals Specialist to join our team. The ideal candidate will play a ... our members receive excellent service and fair resolution of grievances and appeals in compliance with regulatory guidelines. This position requires strong… more
- CDPHP (Albany, NY)
- …values and invites you to be a part of that experience. The Clinical Appeals Specialist is responsible for adhering to a member/provider appeal and grievance ... Using knowledge of clinical nursing and medical practices, the Clinical Appeals Specialist will review medical necessity requests, render determinations… more
- Elevance Health (San Antonio, TX)
- …but are not limited to: + Conducts investigation and review of customer grievances and appeals involving provision of service and benefit coverage issues. ... medical staff or outside consultant. + Triages clinical and non-clinical inquiries, grievances and appeals , prepares case files for member grievance… more
- BayCare Health System (Clearwater, FL)
- …responsibility and clinical excellence. **Summary:** + Handles and processes customer appeals and grievances in accordance with established guidelines, company ... policies, and legal regulations. + Receive and document customer appeals and grievances via multiple channels (phone, email, online portals) in systems. + Ensure… more
- New York State Civil Service (Schenectady, NY)
- NY HELP Yes Agency NYS Gaming Commission Title Human Resources Specialist 1 or Human Resources Specialist Trainee 1 Occupational Category Administrative or ... Code 12305 Duties Description Duties:Under the general supervision of the Human Resources Specialist 2 the incumbent will serve as a generalist and will provide a… more