Current jobs related to Customer Solutions Center Appeals and Grievances Training Specialist II - Los Angeles, California - Scout Exchange
-
Los Angeles, California, United States Scout Exchange Full timeJob 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...
-
Los Angeles, California, United States Scout Exchange Full timeJob Summary:The Customer Solutions Center Appeals and Grievances (A&G) Training Specialist II is a key role in the department, responsible for designing and conducting training programs using established regulatory and departmental guidelines. This position provides ongoing training on the core processing system, A&G processing procedures, and regulatory...
-
Los Angeles, California, United States CCG Business Solutions, LLC Full timeJob 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...
-
Appeals and Grievances Resolution Specialist
4 weeks ago
Los Angeles, California, United States Insight Global Full timeJob 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,...
-
Appeals and Grievances Specialist I
4 weeks ago
Los Angeles, California, United States Insight Global Full timeJob SummaryThe Appeals and Grievances Specialist I will support the Appeals and Grievances team in receiving, investigating, and resolving member and provider complaints and appeals. This role will escalate complex issues or questions to leadership as appropriate.Key ResponsibilitiesLearn the specialty level appeals and grievances work by resolving less...
-
Claims Support Manager II Grievance/Appeals
4 weeks ago
Los Angeles, California, United States Elevance Health Full timeJob Summary:Manager II Grievance/Appeals is responsible for management oversight of grievances and appeals departmental units to investigate, resolve, and respond to client/provider grievances/appeals and ensure compliance with regulatory requirements.Key Responsibilities:Maintains and coordinates staff activities to achieve departmental and corporate goals...
-
Customer Service Specialist II
4 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeJob SummaryThe Customer Solution Center Appeals and Grievances Specialist II plays a critical role in ensuring the highest level of service to our members and providers. This position is responsible for receiving, investigating, and resolving member and provider complaints and appeals, exercising strong independent judgment.This role requires a deep...
-
Grievance & Appeals Specialist
4 weeks ago
Los Angeles, California, United States AppleOne Full timeJob 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...
-
Medicare Claims Appeals Specialist
4 weeks ago
Los Angeles, California, United States Med National Staffing Inc. Full timeJob 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...
-
Regulatory Compliance Specialist II
4 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeJob SummaryThe Regulatory Compliance Specialist II is responsible for ensuring the Customer Solution Center (CSC) is ready for regulatory audits. This position will develop a successful auditing strategy for end-to-end processes within CSC, including enrollment processing, timeliness and accuracy of loading members, and outbound health risk assessment calls....
-
Information Technology Specialist I
4 weeks ago
Los Angeles, California, United States Office of Tax Appeals Full timeJob Title: Information Technology Specialist IThe Office of Tax Appeals is seeking a highly skilled Salesforce developer to join our team as an Information Technology Specialist I. As a key member of our IT department, you will be responsible for analyzing our case management processes and ensuring that our Salesforce workflows meet the business needs of our...
-
Loan Specialist II
1 month ago
Los Angeles, California, United States INSPYR Solutions Full timeJob Title: Loan Specialist IIJob Summary:As a Loan Specialist II at INSPYR Solutions, you will play a crucial role in processing commercial and retail loans, preparing approval or closing documents, and ensuring accuracy and completeness of loan files. You will work under direct supervision, utilizing your knowledge and skills gained through on-the-job...
-
Loan Specialist II Position
1 month ago
Los Angeles, California, United States INSPYR Solutions Full timeJob Title: Loan Specialist IILocation: Grand Ave., Los Angeles, CA 90071 (Hybrid three times a week in office.)Job Type: ContractCompensation: $30-$Work Requirements: US Citizen, GC Holders or Authorized to Work in the USWe are seeking a skilled Loan Specialist II to join our team at INSPYR Solutions. As a Loan Specialist II, you will be responsible for...
-
Loan Specialist II
4 weeks ago
Los Angeles, California, United States INSPYR Solutions Full timeJob Summary: As a Loan Specialist II at INSPYR Solutions, you will play a crucial role in processing commercial and retail loans, preparing approval or closing documents, and ensuring compliance with all state and federal regulations. This position requires strong analytical and problem-solving skills, as well as the ability to work independently and...
-
GIS Specialist II
1 month ago
Los Angeles, California, United States CMTS Full timeJob Title: GIS Specialist IIJob Summary:CMTS is seeking a highly motivated GIS Specialist II to join our team in Los Angeles, CA. As a GIS Specialist II, you will be responsible for developing and supporting LAWA's ArcGIS Indoors information model for wayfinding and space planning.Key Responsibilities:* Develop and maintain web and mobile geospatial...
-
Clinical Operations Supervisor RN
4 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeJob SummaryThe Clinical Operations Supervisor RN is responsible for overseeing the day-to-day clinical operations of the Appeals and Grievances department. This includes ensuring proper staffing and coverage, monitoring and evaluating departmental operations, and documenting and addressing any deviations in work or organizational expectations.This role...
-
Client Support Operations Manager
4 weeks ago
Los Angeles, California, United States Specialist Direct Full timeAbout Specialist DirectWe are a leading telehealth company specializing in organ transplant services. Our cloud-based diagnostic solutions have improved organ utilization and increased placements nationwide.The RoleAs our Client Support Manager, you will oversee our 24/7 Client Support team, ensuring seamless client interactions and efficient workflow...
-
Product Solutions Manager II
4 weeks ago
Los Angeles, California, United States L.A. Care Health Plan Full timeJob Title:Product Solutions Manager IIJob Summary:The Product Solutions Manager II is a key member of the Product Strategy, Sales and Marketing (PSSM) service area, responsible for identifying and implementing projects, programs, and initiatives that support the achievement of product and enterprise goals.Key Responsibilities:Develops, designs, and...
-
GIS Specialist II
1 month ago
Los Angeles, California, United States Cordoba Full timeJob SummaryCordoba Corporation is seeking a highly skilled GIS Specialist II to support our Facilities Sector. As a key member of our team, you will play a crucial role in planning and designing capital investments, including airfield improvements, terminal improvements, infrastructure improvements, and more.You will develop and support the client's ArcGIS...
-
Roofing Technical Specialist
4 weeks ago
Los Angeles, California, United States Roof Repair Specialist Full timeJob DescriptionWe are seeking a skilled Roofing Technical Services Representative to join our team at Roof Repair Specialist. As a leading roofing company in LA county, we require someone with extensive experience in roofing and construction to help with leak detection and repair on customer projects.This role demands a combination of technical expertise and...
Customer Solutions Center Appeals and Grievances Training Specialist II
1 month ago
This role is responsible for designing and delivering training programs to enhance the skills and knowledge of the Customer Solutions Center Appeals and Grievances team.
Key Responsibilities:- Develop and implement training strategies to improve employee performance and productivity.
- Design and deliver training programs on regulatory changes, quality and performance guidelines, and departmental policies and procedures.
- Conduct training needs assessments and lead the design and delivery of curriculum and learning materials.
- Maintain documentation, including training agendas, sign-in sheets, and database/system updates.
- Work with key stakeholders to monitor error trends, productivity, and quality standards.
- Identify gaps in knowledge, skills, and abilities and recommend training/education measures to resolve issues and enhance staff performance.
- Propose program modifications to enhance performance and positively influence member satisfaction survey results.
- Conduct assessments after training to measure, record, and report feedback on training material and sessions.
- 3 years of experience in the Healthcare Industry.
- 3 years of experience designing and conducting trainings.
- Bachelors Degree or equivalent experience.
- Managed Care experience and Appeals & Grievances experience, preferably as a Lead.
