Appeals and Grievances Specialist I

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...

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...

Job 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...

Job 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...

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...

Job 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...

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 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...

Job 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...

Job 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....

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,...

Skanska is seeking a skilled Labor Relations Specialist to join our team. This role is critical to managing labor relations and ensuring compliance with collective bargaining agreements (CBAs) within our construction division.The ideal candidate will have at least five years of experience in the construction industry and possess a deep understanding of...

Job SummaryThe California Department of Corrections and Rehabilitation is seeking a highly skilled Personnel Supervisor I to join our team. As a key member of our personnel management team, you will be responsible for supervising and providing technical assistance to personnel specialists, performing personnel and payroll duties, and reviewing transactions...

Job Title: Clinical Nursing Director IUnder the direction of the Department of Health Services Chief Nursing Officer, the Clinical Nursing Director I works closely with system, regional, and site leaders to develop, implement, and maintain strategic and operational initiatives for nursing workforce utilization.The incumbent will monitor and trend workforce...

Clinical Nursing Director I Job DescriptionThe County of Los Angeles is seeking a highly skilled and experienced Clinical Nursing Director I to join our team. As a key member of our healthcare leadership team, you will be responsible for developing, implementing, and maintaining strategic and operational initiatives for nursing workforce utilization.Key...

About the Role:Skechers U.S.A. is seeking a highly motivated and customer-focused Retail Product Specialist to join our team. As a key member of our sales floor team, you will be responsible for delivering exceptional customer experiences and ensuring our stores are visually appealing and well-stocked.Key Responsibilities:Engage with customers to understand...

Job SummaryCedars-Sinai is seeking a Clinical Research Data Specialist I to manage data for assigned research studies. This role involves designing forms for data collection, clinical data abstraction, processing data, maintaining record systems, and producing project reports for studies.The ideal candidate will have a bachelor's degree or equivalent in...

Medical Collection SpecialistVolt is seeking a highly skilled Medical Collection Specialist to join our team. As a Medical Collection Specialist, you will be responsible for reviewing records for outstanding and unpaid claims, contacting payor sources to determine the status of payments, and maintaining records and preparing reports.Key...

Clinical Research Data Specialist ICedars-Sinai is a leader in biomedical research and training, attracting renowned physician-scientists seeking an unparalleled environment for fostering innovation and teamwork.The Clinical Research Data Specialist I plays a critical role in managing data for assigned research studies, ensuring compliance with federal and...