We have other current jobs related to this field that you can find below
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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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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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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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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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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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El Dorado Hills, United States Blue Shield of California Full timeYour 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...
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El Dorado Hills, United States Blue Shield of California Full timeYour 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...
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El Dorado Hills, United States Blue Shield of California Full timeYour 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...
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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...
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Woodland Hills, United States Blue Shield of California Full timeYour Role The Medicare Appeals and Grievances Non-Clinical team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Appeals and Grievances Representative, Specialist will report to the Operations Supervisor. In this role you will be responsible for oversight of team reviewing, researching, and responding to...
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Woodland Hills, United States Blue Shield of California Full timeYour Role The Medicare Appeals and Grievances Non-Clinical team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Appeals and Grievances Representative, Specialist will report to the Operations Supervisor. In this role you will be responsible for oversight of team reviewing, researching, and responding to...
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Woodland Hills, United States Blue Shield of California Full timeYour Role The Medicare Appeals and Grievances Non-Clinical team receives, documents, investigates, refers, and coordinates grievances, appeals and complaints. The Appeals and Grievances Representative, Specialist will report to the Operations Supervisor. In this role you will be responsible for oversight of team reviewing, researching, and responding to...
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El Dorado Hills, CA, United States Blue Shield of California Full timeYour 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...
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United States, CA, El Dorado Hills Blue Shield of California Full timeYour 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...
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El Dorado Hills, United States Blue Shield of California Full timeYour Role The Commercial Appeals and Grievances team performs comprehensive research related to the facts and circumstances of member complaints, appeals and grievances. The Commercial Appeals and Grievances Operations Specialist - Experienced will report to a Commercial Appeals and Grievances Supervisor. In this role you will partner with the Commercial...
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Supervisor, Operations
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El Dorado Hills, United States Blue Shield of California Full timeYour 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,...
Appeals and Grievances Representative, Intermediate
2 months ago
Your Role
The ?Blue Shield Promise Medi-Cal Appeals and Grievance team researches and resolves member/subscriber grievances, appeals, and interprets and explains health plan benefits,?policies,?and procedures to Medi-Cal enrollees. The ?Medi-Cal Appeals and Grievance Coordinator? will report to the ?Operations Supervisor. In this role you will? be responsible for producing complex written correspondence within timeliness compliance, resolving member grievances and appeals specific to mandates, and meeting Regulatory timeframes??.
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 benefits, policies, procedures, and functions to members and providers.
- Administer ongoing grievance tracking, trending, and reporting for assigned grievances.
- Must be willing to work unplanned overtime or Saturdays as inventory demands may increase.
Your Knowledge and Experience
- Requires a high school diploma or GED
- Requires at least 2 years in health insurance operations such as I&M, Claims, Customer Services, Regulatory Affairs and/or Appeals/Grievances or similar combination
- ???General knowledge of applicable legislation/regulations and compliance?. ?
- ????Demonstrated proficiency with free format letter writing required?.
- ?Experience with Microsoft Office applications required?.?
Pay Range:
The pay range for this role is: $ 20.48 to $ 28.67 for California.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
