Regulatory Complaint Coordinator, Intermediate-CalPERS
12 hours ago
Your RoleThe CalPERS team within the Appeals and Grievance Department is responsible for processing and responding to Appeals and Grievances as well as inquiries received directly from CalPERS members, regulatory agencies and CalPERS directly. The Regulatory Complaint Coordinator, Intermediate, will report to the CalPERS Supervisor. In this role you will perform comprehensive research related to the facts and circumstances of member complaints, appeals, and grievances. You will also be responsible for effectively managing your time daily to ensure you are meeting and/or exceeding compliance, quality, and production metrics.Your WorkIn this role, you will:* Prepare detailed file summary responses for submission to multiple regulatory, legislative, and accreditation agencies.* Be involved in evaluating and researching end-to-end timelines of member health provider services, claim processing, and other data to determine decision and/or alternative ways to resolve grievance/appeal.* Respond to the most complex and highest financial and/or goodwill impact regulatory complaint inquiries.* Research the data files and develop a timeline of events and gather missing information from third parties such as medical providers, to determine the response to the inquiry.* Respond to correspondence addressed to highest level executives regarding issues and/or concerns that an individual (member or non-member) may have.* Respond to all CalPERS Request for Health Plan Information (RHPI) requests according to timeliness requirements.* Communicate actively with Leadership, other departments, regulatory agencies, etc. to resolve issues relating to CalPERS appeals and grievance processing* Other responsibilities/duties as assigned
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El Dorado Hills, United States Blue Cross and Blue Shield Association Full timeYour Role The CalPERS team within the Appeals and Grievance Department is responsible for processing and responding to Appeals and Grievances as well as inquiries received directly from CalPERS members, regulatory agencies and CalPERS directly. The Regulatory Complaint Coordinator, Intermediate, will report to the CalPERS Supervisor. In this role you will...
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El Dorado Hills, United States Blue Shield of California Full timeThe Cal. PERS team within the Appeals and Grievance Department is responsible for processing and responding to Appeals and Grievances as well as inquiries received directly from Cal. PERS members, regulatory agencies and Cal. PERS directly. The Regul Regulatory, Media, Coordinator, Processing, Insurance, Business Services
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El Dorado Hills, United States Blue Shield of California Full timeThe Cal. PERS team within the Appeals and Grievance Department is responsible for processing and responding to Appeals and Grievances as well as inquiries received directly from Cal. PERS members, regulatory agencies and Cal. PERS directly. The Regul Regulatory, Media, Coordinator, Processing, Insurance, Business Services Learn More
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Regulatory Case Manager
6 days ago
El Dorado Hills, California, United States Blue Shield of California Full timeJob DescriptionIn this exciting role as a Regulatory Complaint Coordinator, you will be part of a dynamic team that handles appeals, grievances, and inquiries for CalPERS. You will work closely with regulatory agencies, CalPERS members, and other stakeholders to provide excellent customer service while ensuring compliance with regulatory requirements.About...
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Appeals and Grievances Representative, Advanced
3 weeks ago
El Dorado Hills, United States Blue Shield of California Full timeAppeals and Grievances Representative, Advanced - CalPERS at Blue Shield of California summary: The Appeals and Grievances Representative is responsible for managing and resolving member appeals and grievances in a timely manner. This role involves answering inquiries, investigating issues, and providing explanations of health plan benefits to members...
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Appeals and Grievances Representative, Advanced
4 weeks ago
El Dorado Hills, United States Blue Shield of California Full timeYour Role The Appeals and Grievances team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Appeals and Grievances, Advanced Coordinator will report to the Appeals and Grievances Supervisor. In this role you will be responsible for taking incoming telephone calls, reviewing, researching, and responding to...
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Appeals and Grievances Representative, Advanced
4 months ago
El Dorado Hills, United States Blue Shield of California Full timeYour Role The Appeals and Grievances team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Appeals and Grievances, Advanced Coordinator will report to the Appeals and Grievances Supervisor. In this role you will be responsible for taking incoming telephone calls, reviewing, researching, and responding to...
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Appeals and Grievances Representative, Advanced
1 month ago
El Dorado Hills, United States Blue Shield Of California Full timeYour Role The Appeals and Grievances team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Appeals and Grievances, Advanced Coordinator will report to the Appeals and Grievances Supervisor. In this role you will be responsible for taking incoming telephone calls, reviewing, researching, and responding to...
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Appeals and Grievances Representative, Advanced
4 weeks ago
El Dorado Hills, United States Blue Shield of California Full timeYour Role The Appeals and Grievances team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Appeals and Grievances, Advanced Coordinator will report to the Appeals and Grievances Supervisor. In this role you will be responsible for taking incoming telephone calls, reviewing, researching, and responding to...
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Appeals and Grievances Representative, Advanced
4 weeks ago
El Dorado Hills, United States Blue Shield of California Full timeYour Role The Appeals and Grievances team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Appeals and Grievances, Advanced Coordinator will report to the Appeals and Grievances Supervisor. In this role you will be responsible for taking incoming telephone calls, reviewing, researching, and responding to...
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Appeals and Grievances Representative, Advanced
4 months ago
El Dorado Hills, United States Blue Shield of California Full timeYour Role The Appeals and Grievances team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Appeals and Grievances, Advanced Coordinator will report to the Appeals and Grievances Supervisor. In this role you will be responsible for taking incoming telephone calls, reviewing, researching, and responding to...
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Appeals and Grievances Representative, Advanced
3 months ago
El Dorado Hills, United States Blue Shield of California Full timeYour Role The Appeals and Grievances team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Appeals and Grievances, Advanced Coordinator will report to the Appeals and Grievances Supervisor. In this role you will be responsible for taking incoming telephone calls, reviewing, researching, and responding to...
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Appeals and Grievances Representative, Advanced
2 months ago
El Dorado Hills, United States Blue Shield of California Full timeYour Role The Appeals and Grievances team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Appeals and Grievances, Advanced Coordinator will report to the Appeals and Grievances Supervisor. In this role you will be responsible for taking incoming telephone calls, reviewing, researching, and responding to...
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Appeals and Grievances Representative, Advanced
4 months ago
El Dorado Hills, United States Blue Shield of California Full timeYour Role The Appeals and Grievances team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Appeals and Grievances, Advanced Coordinator will report to the Appeals and Grievances Supervisor. In this role you will be responsible for taking incoming telephone calls, reviewing, researching, and responding to...
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Appeals and Grievances Representative, Advanced
4 months ago
El Dorado Hills, United States Blue Shield of California Full timeYour Role The Appeals and Grievances team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Appeals and Grievances, Advanced Coordinator will report to the Appeals and Grievances Supervisor. In this role you will be responsible for taking incoming telephone calls, reviewing, researching, and responding to...
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Appeals and Grievances Representative, Advanced
3 weeks ago
El Dorado Hills, CA, United States Blue Shield of California Full timeAppeals and Grievances Representative, Advanced - CalPERS at Blue Shield of California summary: The Appeals and Grievances Representative is responsible for managing and resolving member appeals and grievances in a timely manner. This role involves answering inquiries, investigating issues, and providing explanations of health plan benefits to members...
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Appeals and Grievances Representative, Advanced
4 weeks ago
El Dorado Hills, CA, United States Blue Shield of California Full timeYour Role The Appeals and Grievances team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Appeals and Grievances, Advanced Coordinator will report to the Appeals and Grievances Supervisor. In this role you will be responsible for taking incoming telephone calls, reviewing, researching, and responding to...
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Appeals and Grievances Representative, Advanced
4 weeks ago
El Dorado Hills, CA, United States Blue Shield of California Full timeYour Role The Appeals and Grievances team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Appeals and Grievances, Advanced Coordinator will report to the Appeals and Grievances Supervisor. In this role you will be responsible for taking incoming telephone calls, reviewing, researching, and responding to...
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Appeals and Grievances Representative, Advanced
4 months ago
El Dorado Hills, CA, United States Blue Shield of California Full timeYour Role The Appeals and Grievances team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Appeals and Grievances, Advanced Coordinator will report to the Appeals and Grievances Supervisor. In this role you will be responsible for taking incoming telephone calls, reviewing, researching, and responding to...
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Appeals and Grievances Representative, Advanced
4 months ago
United States, CA, El Dorado Hills Blue Shield of California Full timeYour Role The Appeals and Grievances team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Appeals and Grievances, Advanced Coordinator will report to the Appeals and Grievances Supervisor. In this role you will be responsible for taking incoming telephone calls, reviewing, researching, and responding to...
