- LA Care Health Plan (Los Angeles, CA)
- Supervisor , Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... support the safety net required to achieve that purpose. Job Summary The Supervisor of Appeals and Grievances Clinical Operations (A&G) RN is responsible for… more
- Point32Health (MA)
- …SUMMARY Under the general direction of the Senior Manager of Appeals and Grievances the Appeals and Grievance Supervisor , through the use of general ... will coordinate and provide leadership for the daily operations of the Appeals and Grievances department. The Supervisor represents the Appeals and… more
- AmeriHealth Caritas (Philadelphia, PA)
- …services. Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor , Appeals and Grievances , this position is ... complaints/issues to management + Monitors to ensure that all problems with appeals / grievances presented by plan members/participants are resolved in accordance… more
- Centene Corporation (Sacramento, CA)
- …experience with claims, appeals , and grievance strongly preferred.** **Position Purpose:** The Supervisor of Appeals & Grievances is accountable for the ... and Appeals Unit members. + Continually trains Unit members concerning grievances , appeals , and provider disputes/ appeals . + Regularly audits work of G&A… more
- Point32Health (Canton, MA)
- …communities. **Job Summary** Under the Supervisor 's direction, the Member Appeals and Grievances Department Coordinator assists with all operational aspects ... of the Member Appeals and Member Grievances process for Commercial, TMP and Public Plans products. Responsibilities include, but are not limited to: distribution… more
- LA Care Health Plan (Los Angeles, CA)
- Lead Customer Solution Center Appeals and Grievances Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & Grievances ... required to achieve that purpose. Job Summary The Lead of Customer Solution Center Appeals and Grievances is responsible for assisting with the development of a… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Administrative, HR, Business Professionals Department: CSC Appeals & ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will...Monitors closure of complaints and works with Quality Control Supervisor to resolve all database issues. Prepare and analyze… 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...Federal and State Regulations. Complete individual summary scorecards for Supervisor feedback. + Track monthly scores on spreadsheet and… more
- Humana (Santa Fe, NM)
- …you answered yes to any of the above you may be a great fit for Humana's Grievances & Appeals Representative 3 role! **What we need your help with:** + Managing ... Training and Nesting you will be assigned to another supervisor and Team Lead within the department** **Work Hours**...** **but are always communicated ahead of the need.** ** Grievances and Appeals (G&A) has an impact… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Clinical Appeals Supervisor directs and coordinates the accurate implementation of the clinical appeal process for ... data and data related to the volume and complexity of the appeals and grievances submitted for resolution. **QUALIFICATIONS:** **Education Level:** High… more