Appeals and Grievances Representative, Intermediate

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...

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...

{"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...

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 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...

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 Our Medi-Cal Customer Experience Teams receive incoming telephone calls from our members who need help navigating their Blue Shield of California Medi-Cal Insurance Coverage. The Medi-Cal Call Centers are open Monday – Friday from 8:00am-6:00pm, including some holidays. If hired, you will be required to attend and complete a...

About the RoleThe Clinical Services Coordinator, Intermediate, plays a vital role in the medical management process at Blue Shield of California. As the initial point of contact for providers and members, this position requires strong communication and interpersonal skills to ensure effective and efficient management of member care.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...

Your Role The Pharmacy Prior Authorization team provides efficient and accurate responses to external customers (physicians, office staff, pharmacy providers, members, and brokers) and internal team members for all outpatient pharmacy benefit inquiries. The Pharmacy Technician, Intermediate, will report to the Operations Supervisor. In this role you will...

Your Role The Pharmacy Prior Authorization team provides efficient and accurate responses to external customers (physicians, office staff, pharmacy providers, members, and brokers) and internal team members for all outpatient pharmacy benefit inquiries. The Pharmacy Technician, Intermediate, will report to the Operations Supervisor. In this role you will...

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...

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...

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...

About the RoleThe Clinical Program Manager Consultant will play a key role in supporting the overall FEP Care Management team as a subject matter expert, while exemplifying Blue Shield of California's leadership behaviors.Key ResponsibilitiesContribute to the Adoption and Improvement of Care Management Electronic Medical RecordsParticipate in go-live...