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The Grievance Resolution Specialist coordinates the Grievance and Appeal resolution process, responds to verbal and written Grievances and Appeals from members and/or providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions, and pharmacy and vision decisions.
$24.52 - $31.04 an hourTemporaryExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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We are seeking a talented Grievance & Appeals Specialist who will be responsible for responding to written/verbal grievances, complaints, appeals, and disputes submitted by members and providers in accordance with NCQA, CMS, State, and other regulations.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Under general supervision of the Grievance and Appeals Manager performs a variety of complex, responsible and confidential duties requiring a thorough knowledge of organizational procedures and precedents perform routine clerical, administrative duties in support of the Grievance and Appeal Department.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Senior Grievance and Appeals Specialist. Knowledge of Medicare/Medicaid Grievance and appeals process. VillageCare is looking for a self-motivated individual for a Full Time role as the Senior Grievance Specialist.
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Monitors, trends, and analyzes grievance and appeals data for submission to appropriate parties. The Manager I - Grievance & Appeals is responsible for the management oversight of receipt, investigation and processing associated with member/provider grievance and appeals.
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Meets performance measurement goals for Grievance and Appeals Resolution Services. Evaluates case details, proposes recommendations, or makes decisions as applicable; ensures organization decision is implemented according to the Grievance and Appeals policies and case resolution.
ExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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ANTHEM is seeking an experienced Traffic Design Engineer to join our team! ANTHEM Consulting Engineers, PLLC is an Orlando-based engineering consulting firm founded in 2021. ANTHEM is where opportunities commend passion, talent, and reliability for personal and professional growth in a company built for strategic advancement.
Full-timeExpandApply NowActive JobUpdated 13 days ago - UpvoteDownvoteShare Job
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They will engage in continuous learning and become increasingly familiar with the health plan grievance and appeals processes over time. The Junior Grievance Coordinator is a supportive member of the Grievance and Appeals team, ensuring AlohaCare members and providers of compliant, ethical, and timely resolution of their grievance or appeal.
$16.5 - $18 an hourExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Dental Care of Anthem Crossroads is looking for a Practice Manager of Operations to join our team. Dental Care of Anthem Crossroads, like each Heartland Dental supported office, is unique to the community and the patients they serve.
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BASIC JOB PURPOSE: Quality Assurance Specialist is responsible for investigating and documenting complaints/grievances received, both internal and external, and to analyze and rrt trending of grievance categories.
Full-timeExpandApply NowActive JobUpdated 19 days ago - UpvoteDownvoteShare Job
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That's why we're seeking a part-time Dentist Assistant
$15 - $21 an hourPart-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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May coordinate the Grievance and Appeals Committee. 2+ years grievance or appeals, claims or related managed care experience. May coordinate the Grievance and Appeals Committee. This is a remote/work-from-home opportunity.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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You can receive 12 CEU credits just for completing our new-hire trainingWhy Hand & Stone Massage and Facial Spa, Anthem Az? We are proud to be family owned and operated locally in Anthem.
$45 - $65 an hourPart-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Minimum of four years of administrative support experience in a health care organization required Knowledge of DOH and CMS Grievance and Appeals regulatory requirements and procedures for ensuring compliance preferred Proficient PC skills, including MS Excel, Word, and Access required Knowledge of Facets system preferred.
ExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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May serve as a backup to absent Grievance & Appeals Nurse Specialists. Knowledge of PHC Grievance & Appeals processes. to Grievance & Appeals Case Analysts to ensure clinical solution followed on casework.
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Title: grievance Company: Anthem
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