Appeals and Grievances Representative, Advanced

As the Appeals & Grievances Nurse, you will play a key role in managing and resolving New Century Health Plan member appeals and grievances. You will: Ensuring timely, accurate, and thorough review of member and provider complaints, working closely w Appeals, Nurse, Healthcare

Description As the Appeals & Grievances Nurse, you will play a key role in managing and resolving New Century Health Plan member appeals and grievances. You will: Ensuring timely, accurate, and thorough review of member and provider complaints, working closely with clinical and administrative teams. Assessing cases to determine the appropriateness of...

Job DescriptionDescriptionAs the Appeals & Grievances Nurse, you will play a key role in managing and resolving New Century Health Plan member appeals and grievances. You will: Ensuring timely, accurate, and thorough review of member and provider complaints, working closely with clinical and administrative teams.Assessing cases to determine the...

Job Summary: We are seeking a highly skilled Appeals and Grievances Specialist II to join our team at Insight Global. As a key member of our Appeals and Grievances team, you will play a critical role in receiving, investigating, and resolving member and provider complaints and appeals.Key Responsibilities:Support the Appeals and Grievances team in receiving,...

Job DescriptionAppleOne is seeking a highly skilled Grievance & Appeals Specialist to join our team. As a key player in the healthcare sector, this role will involve processing intakes, acknowledging complaints, and preparing case files for investigation and resolution. The ideal candidate will have strong independent judgment and be able to escalate complex...

Salary Range: $67,186.00 (Min.) - $87,342.00 (Mid.) - $107,498.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make...

Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II is primarily responsible for the overall coordination of the Appeals & Grievance (A&G) program for L.A. Care Health Plan members under the direct supervision and management of the A&G Nurse Specialist, RN and/or Medical Director. This position provides assistance to...

Supervisor, Appeals and Grievances Clinical Operations RN Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 11617 Salary Range: $102,183.00 (Min.) - $132,838.00 (Mid.) - $163,492.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency...

Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 11505 Salary Range: $60,778.00 (Min.) - $75,950.00 (Mid.) - $91,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California...

Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 11145 Salary Range: $60,778.00 (Min.) - $75,950.00 (Mid.) - $91,166.00 (Max.) Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California...

Job DescriptionJob Title: Customer Solutions Center Appeals and Grievances Training Specialist IIJob Type: Hybrid | PermanentLocation: Los Angeles, CA (Position will be Hybrid - will be conducting combination WebEx and in near future Onsite Trainings)Required Skills:3 years experience in Healthcare Industry3 years experience designing and conducting...

Title - Customer Solution Center Appeals and Grievances Training Specialist II Job Type - Hybrid | Permanent Location - Los Angeles, CA (Position will be Hybrid - will be conducting combination WebEx and in near future Onsite Trainings. Person must be flexible. Person will need to be working in state remote when working from home). Required: Must have 3...

Job DescriptionJob DescriptionJob Description: We are seeking a detail-oriented Medicare Claims Appeals Specialist with a comprehensive understanding of Medicare claims processing, including provider contracts, Division of Financial Risk (DOFR), explanation of benefits, and claim edits. The ideal candidate will have a strong grasp of CMS provider appeals...

Job DescriptionWe are seeking a detail-oriented Medicare Claims Appeals Specialist with a comprehensive understanding of Medicare claims processing, including provider contracts, Division of Financial Risk (DOFR), explanation of benefits, and claim edits.Key Responsibilities:Review and process Medicare provider appeals cases for California clients, adhering...

Nurse Appeals – Licensed RN Nurse Location: This position will work in a hybrid model (remote and office). Ideal candidates will live in the state of California within 50 miles of one of our PulsePoint locations. Shift: Monday to Friday from 8:00am-5:00pm PST The Nurse Appeals is responsible for investigating and processing medical necessity appeals...

Job DescriptionThe Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II is responsible for providing ongoing training on the core processing system, A&G processing procedures, training regulatory changes which will affect established procedures, working with the quality team on quality and performance guidelines, creating and...

Job DetailsDescriptionUnion Representative/Organizer-Strategic CampaignsWe represent over 10,000 California state employees in ten different bargaining units. We negotiate and enforce a complex contract that ensures good working conditions, fair wages, and secure health care and retirement benefits.Key ResponsibilitiesIdentify, recruit, train, and develop...

Job DescriptionJob DescriptionHighly regarded and prominent key player in the healthcare sector is active interviewing for a Grievance & Appeals Specialist. This role will be a remote role and Co. is asking for local individuals to Los Angeles, CA as you will need to drive into the Co. occasionally. As the designated Rep you will be processing: Intakes,...

About the RoleThe Senior Care Manager will play a critical part in supporting the mission of Blue Shield of California, providing care coordination services to patients in the outpatient setting. This role is a key component of the healthcare team, ensuring that services are delivered in a standardized manner, including coordination of care with specialists,...

Position: Customer Service Rep - Bilingual Korean Location: Pasadena Temp to Perm Possibility Schedule: Monday - Friday (9 am - 6 pm or 10 am - 7pm) ESSENTIAL JOB FUNCTIONS: Documents all communications involving beneficiary and provider contacts. Answer incoming calls from our customers to include but not limited to members, providers, health plans,...