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Grievance Coordinator Jobs

Investigator Ii - Inmate Grievance
By Texas Department Of Criminal Justice At Texas City, TX, United States
Law Enforcement & Custodial Officers System (LECOS) Retirement
Telephonic Interviews Will Not Be Accepted
Work Site Visits Will Not Be Conducted
Graduation from an accredited senior high school or equivalent or
Three years full-time, wage-earning criminal justice, clerical,
The salary for an ERS Retiree (or non-contributing member) will
Investigator Ii - Inmate Grievance
By Texas Department Of Criminal Justice At Beeville, TX, United States
Law Enforcement & Custodial Officers System (LECOS) Retirement
Telephonic Interviews Will Not Be Accepted
Work Site Visits Will Not Be Conducted
Graduation from an accredited senior high school or equivalent or
Three years full-time, wage-earning criminal justice, clerical,
The salary for an ERS Retiree (or non-contributing member) will
Grievance And Appeals Coordinator - Remote | Wfh
By Get It Recruit - Healthcare At Sacramento, CA, United States

Are you a skilled communicator and problem solver with a knack for clear, concise writing? We're seeking a dedicated Member Support Specialist to join our team. As a crucial link between our members ...

Appeals & Grievance - Rn
By Yamhill Community Care At , Mcminnville
Knowledge of Managed Care / Medicaid requirements.
Maintains confidentiality of all discussions, records, and other data in connection with quality management activities according to professional standards.
Any combination of education and experience that would qualify candidate for the position.
Health care benefit and regulatory knowledge.
Knowledge of Oregon Medicaid grievance system requirements.
Ensures resolutions are compliant and meets turnaround times requirements dictated by policies and procedures.
Grievance & Appeals Specialist- Remote
By EmblemHealth At New York, NY, United States
Relevant Work Experience, Knowledge, Skills, And Abilities
Additional years of experience/training may be considered in lieu of educational requirements. (R)
Excellent organization and time management skills. (R)
Experience in a managed care/compliance environment. (P)
Determine eligibility, benefits, and prior activity related to the claims, payment or service in question.
3+ years of related professional work experience. (R)
Grievance/Appeals Analyst I (Us)
By Elevance Health At California, United States
Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical information.
12898 Towne Center Drive, Cerritos, CA
3080 Bristol Street, Costa Mesa, CA
11030 White Rock Road, Rancho Cordova, CA
1121 L St., Suite 500, Sacramento, CA
2121 N. California Boulevard, Walnut Creek, CA
Appeals And Grievance Coordinator
By BroadPath At United States
2+ years of Medicare Appeals/Grievance experience required
Must have strong technical skills (Microsoft Windows, keyboarding skills, strong systems aptitude, etc.)
Excellent verbal and written communication skills
However, based on performance BroadPath can offer other opportunities based on availability once the contract ends.
Processing Medicare Appeals/Grievance with Medicare Part C or D experience
Notifying the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue
Member Grievance & Appeals Liaison
By Commercial Solutions At , , Az
Utilize multiple systems to investigate escalated inquiries on Members and follow the member experience from beginning to resolution
Manage resolution of activities in CRM, including HICS from CMS according to defined turnaround times
Collaborate with internal teams and external partners to resolve complaints and document issue and resolution in CRM
Conduct member outreach based on a variety of trends such as frequent caller data and out of network claim denials
Recommend workflows and policy as a result of Member feedback and escalation data analysis
Document appropriate client specific information in CRM
Manager Of Grievance And Appeals
By Delta Dental Ins. At , Alpharetta, Ga
Excellent organizational and time management skills, with the ability to multi-task while maintaining attention to detail.
8+ years w/Bachelor's degree; 1+ years supervisory/management
Minimum 5 years' experience in health insurance, with 3 years' experience in grievance and appeals and/or healthcare regulation and law
Strong critical thinking and analytical skills.
Strong interpersonal, written, and verbal communication skills.
Intermediate knowledge of Microsoft Office programs, i.e. Word, Excel, Outlook etc.
Manager, Grievance And Appeals
By CareSource At , Remote $76,700 - $122,700 a year
Minimum of three (3) years of management experience is preferred
Basic experience with Call Management Systems
Strong interpersonal skills, high level of professionalism and a collaborative management style
Manage staff to ensure timely and accurate completion of tasks and issues are accomplished
Oversee and monitor processes to ensure department is meeting all regulatory requirements and accreditation standards
Review and interpret regulatory requirements and ensure business policies and processes are in compliance
Grievance And Appeals Representative 3
By Humana At , Tampa, 33610, Fl
Must meet all Work at home (WAH) requirements
Humana will provide work at Home associates with telephone equipment appropriate to meet the business requirements for their position/job
Prior experience interpreting Member Benefits and Medical Claims
Experience with the ability to prioritize and manage inventory and workflow
Strong technical skills with the ability to work across multiple software systems and comfortable work remote out of your home
Manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted.
Grievance And Appeals Representative 3
By Humana At , San Juan, 00918, Pr
Must meet all Work at home (WAH) requirements
Humana will provide work at Home associates with telephone equipment appropriate to meet the business requirements for their position/job
Prior experience interpreting Member Benefits and Medical Claims
Experience with the ability to prioritize and manage inventory and workflow
Strong technical skills with the ability to work across multiple software systems and comfortable work remote out of your home
Manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted.
Grievance And Appeals Coordinator
By Accede Solutions Inc (accedesol.com) At Illinois, United States

Education/Experience: High school diploma or equivalent. Associate’s degree preferred.0-2 years of experience

Manage large volumes of documents including copying, faxing and scanning incoming mail.