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Grievance Specialist 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 & Appeals Quality Assurance Specialist
By SnugZ USA At New York, NY, United States
3 years quality management experience
Use problem solving skills and business knowledge to make recommendations for process remediation or improvement.
Update current workflows and draft future workflows, incorporating regulatory requirements, quality, and efficiency within design.
Auditing, researching, analyzing and evaluating grievance and appeals data to assess compliancy between process and the corresponding CMS and DOH regulations.
Coordinate, facilitate and document audit walkthroughs.
Develop training and refresher training.
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
Quality Assurance Specialist, Appeals & Grievance
By Alignment Health At California, United States
Produces departmental quality performance reports for management review.
2+ years of managed healthcare experience.
Knowledge of Medicare Managed Care Plans required.
Possess the knowledge of Appeals and Grievance procedures and the Centers for Medicare (CMS) regulatory compliance guidelines.
Analyzes and validates accuracy of Appeals and Grievance data according to plan business and CMS regulatory technical reporting requirements.
2+ years healthcare appeals & grievances experience, related QA experience, or training/supervisory role.
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
Administrative Law Judge-Wv Public Employees Grievance Board-Kanawha Co.
By State of West Virginia At , , Wv
OR by mailing or personally delivering to:
1701 5th Avenue, Suite 2
WV Public Employees Grievance Board
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.
Medicare Advantage Appeals And Grievance Nurse
By Blue Cross and Blue Shield of Kansas City At , Remote
Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals.
Competitive benefits package with day one eligibility
Maintains a current knowledge of CMS rules and regulations relating to the grievance and appeal processes.
Formulates determination language that resolves member or provider issues in a manner consistent with regulatory and accrediting agency requirements
Provides training, leadership and mentoring for less experienced appeal RN and administrative staff.
2 years of appeals and UM experience in a payer-based environment
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.

Are you a problem solver? Do you have a passion for helping others? We are looking for a Grievance Specialist to join our team and help resolve customer complaints. If you have excellent communication and organizational skills, this could be the perfect job for you!

Overview:

A Grievance Specialist is responsible for providing support to employees and management in resolving workplace grievances. They investigate and analyze employee complaints, provide guidance to management on how to handle grievances, and ensure that all grievances are resolved in a timely and fair manner.

Detailed Job Description:

Grievance Specialists are responsible for investigating and resolving employee grievances in a timely and fair manner. They must be knowledgeable of labor laws and regulations, and be able to interpret and apply them to the situation at hand. They must be able to communicate effectively with both employees and management, and be able to provide guidance to management on how to handle grievances. They must be able to conduct interviews with employees and management, and be able to analyze and interpret the information gathered. They must be able to make recommendations to management on how to resolve grievances, and be able to ensure that all grievances are resolved in a timely and fair manner.

What is Grievance Specialist Job Skills Required?

• Excellent communication and interpersonal skills
• Knowledge of labor laws and regulations
• Ability to interpret and apply labor laws and regulations
• Ability to conduct interviews and analyze information
• Ability to make recommendations to management
• Ability to resolve grievances in a timely and fair manner
• Ability to work independently and as part of a team

What is Grievance Specialist Job Qualifications?

• Bachelor’s degree in Human Resources, Labor Relations, or a related field
• At least two years of experience in a labor relations or human resources role
• Knowledge of labor laws and regulations
• Excellent communication and interpersonal skills
• Ability to analyze and interpret information
• Ability to make recommendations to management

What is Grievance Specialist Job Knowledge?

• Knowledge of labor laws and regulations
• Knowledge of grievance procedures
• Knowledge of human resources policies and procedures
• Knowledge of labor relations
• Knowledge of conflict resolution techniques

What is Grievance Specialist Job Experience?

• At least two years of experience in a labor relations or human resources role
• Experience in conducting interviews and analyzing information
• Experience in resolving grievances in a timely and fair manner
• Experience in providing guidance to management on how to handle grievances

What is Grievance Specialist Job Responsibilities?

• Investigate and analyze employee grievances
• Provide guidance to management on how to handle grievances
• Ensure that all grievances are resolved in a timely and fair manner
• Communicate effectively with both employees and management
• Interpret and apply labor laws and regulations
• Make recommendations to management on how to resolve grievances