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Oversees annual giving functions, including giving days, unit-based appeals, parent appeals, faculty/staff/retiree appeals, crowdsourcing, student callers, and related activities.
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Provide legal support to the PHP Appeals & Grievances department on member and provider disputes, including managing Medicaid Fair Hearings, Medicare administrative law judge, and Commercial OSI hearing processes.
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Provides expert level guidance and support for the E/LR unit to ensure employees understand their responsibilities, rights, the procedures and timeframes under various avenues of dispute resolution including administrative grievance procedures, the Equal Employment Opportunity (EEO) complaints systems, appeals to the MSPB, complaints to the Office of the Inspector General (OIG), Department of the Interior.
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Respond to written inquiries and appeals in a timely and professional manner. Provide polite, accurate, and professional customer service related to eligibility, dental benefits, and claims payment; performs claim and benefit research, reconciliation, adjudication, data entry, adjustments, and related reporting.
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Arguments are presented in written appellate pleadings and through occasional oral argument at the New Mexico Court of Appeals and Supreme Court. Meet with clients, file and argue motions, investigate cases, interview witnesses, proceed to trial and file any necessary appeals.
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Acts as a brand ambassador and reflects the company values; partners with the leadership team on the creation of an engaging visual experience that appeals to the FP customer. In collaboration with the store team, the Assistant Visual Manager supports the selling, service, and operations of the store with an emphasis on merchandising and display to create an inspiring and dynamic visual experience for the customer.
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Responsible for the oversight of 4 departments, and growth of directors and associate director, fully developing leaders of leaders: Case Management, Disease Management / Personal Nurse, Utilization Management / Appeals, and Experience and Optimization team.
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Assisting in preparing appeals, impartial medical reviews, rebuttals, and coordinates the assignment of Service member's legal counsel. Serving as a liaison between the Service member, their respective commander and a multi-disciplinary team of primary care managers, other appropriate health care professionals, medical care case managers, non- medical case managers, patient administration personnel, the service-specific offices, the PEB and the Military Department Wounded Warrior Program liaison or advocate.
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Reviews and analyzes Revenue Agent, Appeals Officer, and Counsel Attorney instructions, reports, case files and support statements, and interprets tax law court decisions, and legal opinions to determine and prepare accurate computations for the most demanding and complex Appeals cases.
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Handling administrative litigation in the DOI Office of Hearings and Appeals and assisting the U.S. Department of Justice (DOJ) with judicial litigation (e.g., conducting research, analysis, and interpretation of legal theory, laws, regulations, judicial and administrative court decisions and other legal documents in the preparation and presentation of assigned litigation, hearings, appeals and negotiations.
$87,878 - $135,851 a yearFull-timeExpandApply NowActive JobUpdated 13 days ago - UpvoteDownvoteShare Job
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DENIALS - Follow up on claims denials; contact appropriate party to research, coordinate and justify needed information; make appropriate corrections, obtain approvals and resubmit claims denials for payments; appeal denials through the payer required appeals process.
$16.32 - $23.84 an hourFull-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Responds to faculty, staff, and student concerns; mediates student issues and grade appeals in coordination with the Dean of Students, Human Resources, Vice President of Academic Affairs Office, and others as appropriate.
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