- Centene Corporation (Tallahassee, FL)
- …strongly preferred.** **Position Purpose:** Supervise the day to day operations of the Appeals and Grievance (A&G) staff and functions within the department ... issues and monitor and distribute case load. + Ensure that the Appeals & Grievance department processes all appeals , grievances and complaints in accordance… more
- Centene Corporation (Sacramento, CA)
- …in California **Healthcare lead experience with claims, appeals , and grievance strongly preferred.** **Position Purpose:** The Supervisor of Appeals ... accountable for the recruitment, hiring, promotion, counseling, and daily supervision of Grievance and Appeals Specialists and administrative support as they… more
- Point32Health (TX)
- …partners, colleagues and communities. **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Member Appeals and ... for the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual… more
- Point32Health (MA)
- …Under the general direction of the Senior Manager of Appeals and Grievances the Appeals and Grievance Supervisor , through the use of general knowledge of ... and provide leadership for the daily operations of the Appeals and Grievances department. The Supervisor represents the Appeals and Grievances Department and… more
- AmeriHealth Caritas (Philadelphia, PA)
- …Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** Reporting to the Supervisor , Appeals and Grievances, this position is responsible for ... of medical management authorizations.; + Research and Investigate member and/or provider appeals and grievance requests, including review of UM/claim denial… more
- LA Care Health Plan (Los Angeles, CA)
- …Grievances is responsible for assisting with the development of a successful and cohesive Appeals and Grievance unit, with a high level of productivity to ... and/or exceed member satisfaction. Responsible for the day to day oversight of Appeals and Grievance Specialist by closely monitoring work, providing feedback on… more
- Commonwealth Care Alliance (Boston, MA)
- …& Responsibilities:** + Conduct monthly case review of a random sample of appeals and grievance cases against previously developed scorecard and Federal and ... 011540 CCA- Appeals & Grievances **Position Summary:** Appeals ...State Regulations. Complete individual summary scorecards for Supervisor feedback. + Track monthly scores on spreadsheet and… 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 & Grievances ... required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor , Authorization Technician Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... the safety net required to achieve that purpose. Job Summary The Supervisor , Authorization Technician supports the Utilization Management (UM) Specialist by handling… more
- Corewell Health (Grand Rapids, MI)
- …experience Extensive knowledge of CMS regulations and process + Previous experience with grievance and appeals processes About Corewell Health As a team member ... Ensure favorable decisions are properly effectuated. Assist the Lead and/or Supervisor in coordinating activities and in the development/collection of materials… more