Grievance Resolution Specialist

Job DescriptionJob SummaryThe Midtown Group is seeking a highly motivated and experienced TEMP - Program Assistant (4) to join our team. Under general supervision, the Program Assistant will assist with specialized services relevant to the Grievance and Appeals Resolution Services (GARS) department. The incumbent will work independently, exercising...

Overview:At Sonrava Health, we are seeking a highly skilled Dental Consultant Specialist to join our Quality Management Team. This role is responsible for performing clinical chart reviews, providing mentoring to our dentists, and contributing to the improvement of our dental services.Responsibilities:• Reviews dental charts for potential quality issues...

Job SummaryTo succeed in this role, you will be oriented and trained as a new industry professional with the ability to analyze workers compensation, general liability, or disability claims and determine benefits due.Essential Functions:Attend and complete designated training programs to develop industry knowledge and skills.Analyze claims data to determine...

Job Summary:The Network Management Manager is responsible for contracting with all provider types and ensuring successful provider network performance related to key financial, operational, and member satisfaction performance indicators.Works closely with other departments to enhance the contracted provider experience consistent with company's mission...

About Astiva Health, Inc.Astiva Health, Inc. is a premier healthcare provider specializing in Medicare and HMO services. Our mission is to deliver comprehensive care tailored to the needs of our diverse community, prioritizing accessibility, affordability, and quality in all aspects of our services.Job SummaryThe Member Service Specialist is responsible for...

Job SummaryThis role supports the Clinical Administration Team in improving Prospect's Medical Management infrastructure and processes. The Clinical Program Specialist will play a critical support role in data analysis, quality assurance, and project management.Key ResponsibilitiesClean and manipulate data files for analysisConduct quality assurance checks...

Job SummaryAmeriPharma is seeking a highly skilled Reimbursement Specialist to join our team. As a Reimbursement Specialist, you will be responsible for accurate and timely claims reimbursement activities, including interactions with third-party payers and patients, as well as maintaining accurate records.Key ResponsibilitiesReviews patient inventory of...

Job Title: Member Experience Associate - Bilingual ChineseAt Alignment Healthcare, we are revolutionizing healthcare for seniors by leveraging our world-class technology platform, innovative care delivery models, and deep physician partnerships. We are seeking a highly motivated and detail-oriented Member Experience Associate to join our...

Job Summary:We are seeking a highly skilled Software Assurance Specialist to join our team at Let AllegiantVETS. As a key member of our software development process, you will be responsible for ensuring the integrity and quality of our software solutions.Key Responsibilities: Conduct thorough certification analysis to ensure software solutions meet required...

Job DescriptionWe are seeking a highly skilled Network Manager - Provider Relations to join our team at Regal Medical Group. As a key member of our Provider Relations Network Management team, you will play a crucial role in supporting our network growth and development initiatives in Southern California.Key Responsibilities:Collaborate with the Director of...

Control Systems Engineer - Incineration SpecialistHeritage Environmental Services is seeking a highly skilled Control Systems Engineer - Incineration Specialist to manage, coordinate, and develop all aspects of Continuous Emission Monitoring Systems and Distributive Control Systems to ensure the facility is operating in a manner safe to human health and the...

Job SummaryThe Customer Service Representative Sr is the first point of contact for members and providers, assisting with questions related to Medical programs for Orange County. The incumbent resolves member inquiries and complaints fairly and effectively, providing information on eligibility, enrollment, benefits, and services to eligible members and...

Job OverviewAmeriPharma is seeking a highly skilled Reimbursement Specialist to join our team. As a Reimbursement Specialist, you will be responsible for accurate and timely claims reimbursement activities, including interactions with third-party payers and patients, as well as maintaining accurate records.Key ResponsibilitiesReviews patient inventory of...

Job Title: Traditional Labor Law AssociateFocused on labor and employment law since 1958, Jackson Lewis P.C.'s 950+ attorneys located in major cities nationwide consistently identify and respond to new ways workplace law intersects business.We help employers develop proactive strategies, strong policies and business-oriented solutions to cultivate...

Job Summary:We are seeking a skilled Network Relations Manager to join our team at Regal Medical Group. As a key member of our organization, you will be responsible for managing our provider network, ensuring smooth operations, and driving growth and development initiatives.Key Responsibilities: Collaborate with the Director of Network Management and Medical...

Job DescriptionWe are seeking a highly skilled Software Integrity Engineer to join our team at Let AllegiantVETS. This role involves collaborating with the development team to ensure that all solution requirements are met and that software is safely released to the user community.The ideal candidate will identify defects, report findings, and work with the...

To excel as a skilled industry professional, you will be trained to analyze workers compensation, general liability, or disability claims and determine benefits due. Key responsibilities include:Essential Functions:Attend and complete designated training programs.Develop expertise in workers compensation, general liability, and disability claims.Apply...

Job SummaryThis role supports the Clinical Administration Team in improving Prospect's Medical Management infrastructure and processes. Key responsibilities include data cleaning and manipulation, quality assurance checks, and project management support. The ideal candidate will have experience working in electronic data systems and proficiency in MS Excel...

Job Summary: We are seeking a detail-oriented and dedicated Paralegal with 2-3 years of probate experience to support our team at AtWork Group. The ideal candidate will have a strong understanding of probate procedures and legal terminology, as well as excellent organizational and time management skills.Key Responsibilities:Assist attorneys in managing...

Job SummaryThis Revenue Cycle Liaison II role is a key position in our team, responsible for ensuring practice satisfaction, accountability, and operational support as it relates to the success of the Revenue Cycle. The ideal candidate will possess a strong desire to share knowledge and promote information sharing both within and outside of the team.Key...