Appeals and Grievances Representative, Intermediate

Your Role   The Clinical Appeals and Grievances team researches and resolves member/subscriber grievances, appeals and complaints, and interprets and explains health plan benefits, policies, and procedures to appellant. The AGD - Intermediate coordinators will report to the team’s Operational Supervisor. In this role you will clarify issues, educate...

Your Work   In this role, you will: Assist with telephone inquiries regarding member appeals. Respond to appeals in grievances and member reconsiderations. Research, review, and resolve high level/high priority member grievances, appeals and complaints, while clarifying issues and educating customers in the process Interpret and explain health plan...

Your Work   In this role, you will: Assist with telephone inquiries regarding member appeals. Respond to appeals in grievances and member reconsiderations. Research, review, and resolve high level/high priority member grievances, appeals and complaints, while clarifying issues and educating customers in the process Interpret and explain health plan...

Your Work   In this role, you will: Assist with telephone inquiries regarding member appeals. Respond to appeals in grievances and member reconsiderations. Research, review, and resolve high level/high priority member grievances, appeals and complaints, while clarifying issues and educating customers in the process Interpret and explain health plan...

About the RoleThe Appeals and Grievances team at Blue Shield of CA is seeking a highly skilled and experienced professional to join our team as an Appeals and Grievances Representative, Advanced. In this role, you will be responsible for handling incoming appeals and grievances, researching and resolving complex issues, and providing exceptional customer...

Your Role   The ​Appeals and Grievances Intake​ team ​receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Appeals and Grievances Coordinator, Advanced will report to the Appeals and Grievances Supervisor. In this role you will be responsible for reviewing, researching and responding to incoming appeals...

Your 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...

Your Role The Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either a preservice, post-service or claim denial. The Appeals and Grievances RN Senior will report to the  Manager of the Appeals and Grievances team. In this role you will perform accurate and timely clinical review of...

Job SummaryMolina Healthcare is seeking a highly skilled and experienced Director, Appeals to lead the Appeals and Grievances Unit. The successful candidate will be responsible for reviewing and resolving member complaints and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by...

Job Title: Grievance & Appeal Lead/SupervisorJob SummaryVerda Healthcare, Inc. is seeking a highly skilled Grievance & Appeal Lead/Supervisor to join our team. As a key member of our organization, you will be responsible for resolving written and verbal grievances, complaints, appeals, and disputes submitted by members and providers in accordance with CMS...

Your Role The Medical Care Solutions Appeals and Grievance team is hiring an RN who will be responsible for leading the clinical appeals and grievance team for the Commercial line of business. The RN manager will report to the RN Senior Manager. In this role you will be responsible for inventory management, staffing, transformation readiness, audit...

{"title": "Advanced Provider Dispute Resolution Coordinator", "subtitle": "Join Blue Shield of CA", "content": "At Blue Shield of CA, we are seeking an Advanced Provider Dispute Resolution Coordinator to join our team. In this role, you will be responsible for researching, reviewing, and resolving high-level/high-priority provider grievances, appeals, and...

About the RoleThe Appeals and Grievances team at Blue Shield of CA is seeking a seasoned leader to drive results and foster a great place to work. As the Senior Manager of Operations, you will provide leadership and support to your team, interact with members and specialty clients, and develop great leaders at all levels.Your ResponsibilitiesLead multiple...

Job Summary1199SEIU is seeking a highly organized and dedicated Union Organizer to represent members at 3rd step grievance hearings, prepare 3rd step grievance, and conduct a general investigation of the case. The ideal candidate will have previous experience with a Healthcare institution as a Union Organizer, Delegate or Activist, and be well-organized and...

About the RoleWe are seeking an Advanced Provider Dispute Resolution Coordinator to join our team at Blue Shield of California. In this role, you will be responsible for researching, reviewing, and resolving high-level/high-priority provider grievances, appeals, and complaints.Key ResponsibilitiesProcess provider appeals and correspondence with minimal...

Your Role   The Commercial Appeals & Grievances department performs comprehensive research related to the facts and circumstances of member complaints, appeals, and grievances. The Commercial Appeals & Grievances Supervisor will report to the Commercial Appeals & Grievances Senior Manager. In this role, you will be accountable for hiring, promoting,...

Your Role The Medicare Member Outreach team is high functioning member facing team that manages an inbound call queue, answers member inquiries, assists with various Medicare Member Engagement initiatives and completes outbound care gap closure outreach. The Correspondence Phone Support, Intermediate will report to the Supervisor, Clinical Quality...

Your Role   The Regulatory Appeals and Grievances team is responsible for compliant processing of appeals and grievances. The Operations, Supervisor will report to the Manager for Appeals and Grievances. In this role you will be responsible for supporting and maintaining the relationships between Blue Shield, and regulators including the Department of...

About the RoleThe Pharmacy Prior Authorization team at Blue Shield of CA is seeking a highly skilled Pharmacy Technician, Intermediate to join their team. As a key member of the team, you will play a critical role in providing efficient and accurate responses to external customers and internal team members for all outpatient pharmacy benefit inquiries.Key...

Your Role The Clinical Services Coordinator, Intermediate (CSC) will report directly to the supervisor of care management support operations and will serve as initial point of contact for providers and members in the medical management process by telephone or correspondence. The CSC will interact telephonically with members as per established protocol or...