Grievance Case Analyst Jobs

66 jobs

The Member Appeal and Grievance Analyst is responsible for the management and coordination of assigned member appeals and formal complaints received at HPHC. This individual works collaboratively with the member and/or the member’s authorized representative and must demonstrate superior customer service skills in all interactions. This individual also prepares cases for presentation, discussion, r...

Job Summary Responsible for reviewing, classifying, researching and resolving member complaints (grievances and/or appeals) and communicating resolution to members or their authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid. Coordinates with pertinent departments to effectuate resolution resulting from grievance and app...

Primary Description: This role will report directly to the Manager of the Hiring Department. Research Analyst will be responsible for researching and responding to complaints received from the Department of Insurances and other regulatory agencies. Primary Responsibilities: Researching and investigating requests for information and complaints received from various sources related to member,...

Primary Description: This role will report directly to the Manager of the Hiring Department. Research Analyst will be responsible for researching and responding to complaints received from the Department of Insurances and other regulatory agencies. Primary Responsibilities: Researching and investigating requests for information and complaints received from various sources related to member,...

Primary Description: This role will report directly to the Manager of the Hiring Department. Research Analyst will be responsible for researching and responding to complaints received from the Department of Insurances and other regulatory agencies. Primary Responsibilities: Researching and investigating requests for information and complaints received from various sources related to member,...

Primary Description: This role will report directly to the Manager of the Hiring Department. Research Analyst will be responsible for researching and responding to complaints received from the Department of Insurances and other regulatory agencies. Primary Responsibilities: Researching and investigating requests for information and complaints received from various sources related to member,...

Primary Description: This role will report directly to the Manager of the Hiring Department. Research Analyst will be responsible for researching and responding to complaints received from the Department of Insurances and other regulatory agencies. Primary Responsibilities: Researching and investigating requests for information and complaints received from various sources related to member,...

Responsible for oversight of a team of Coordinator(s), Specialist(s), Analyst(s) and/or Sr. Analyst(s) that performs research, case management and resolution for Med D grievances. This position will be responsible for managing multiple priorities and high-profile tasks, some with short deadlines. Coaching, mentoring, monitoring, and reporting on team performance are a priority in this role. Respon...

Job Category: Customer Service, Medicare Clinical Licensure Required : N/A Job Type: Full Time Position Summary: Responsible for oversight of a team of Coordinator(s), Specialist(s), Analyst(s) and/or Sr. Analyst(s) that performs research, case management and resolution for Med D grievances. This position will be responsible for managing multiple priorities and high-profile tasks, some with sho...

Job Category: Business Analyst Clinical Licensure Required : N/A Job Type: Full Time Position Summary: This role is responsible for processing, resolving, and responding to account issues and/or member concerns as identified in a formal CTM or Grievance, accordance with CMS guidance and Standard Operating Procedures. A firm knowledge of and a responsibility to meet or exceed the CMS imposed tim...

Overview: Provide assistance to Grievance & Appeal team in maintaining records and processing grievances and appeals for all lines of business within the timelines set by regulators. Provide assistance and guidance to internal and external customers regarding grievance/appeals policies and procedures. Ensure member satisfaction and help establish best practices. Responsibilities: Process intake...

Clinical Analyst Your IT skills are needed just about anywhere. But is it where you want to go? Imagine working for one of the nation's most respected companies. Making a strategic contribution. Receiving the rewards and recognition you deserve. Whether you are pursuing a contract or permanent placement, Experis knows how and where to get you where you want to go. In this Clinical Analyst positi...

Human Resources Compensation Analyst with strong FMLA and ADA experience *Must have recent experience in Grievance, FMLA and Investigations * Administering the employee compensation and leave benefits * Overseeing the administration of the company's Workers' Compensation Program * Overseeing the FMLA and ADA issues, as well as, employee relations and investigations. * Investigate ad...

Are you good with people and numbers? The Air Line Pilots Association, International (ALPA), the largest airline pilot union in the world and the largest non-governmental aviation safety organization in the world seeks an Economic Analystfor our Herndon, Virginia, office. ALPA represents over 51,000 pilots at 30 U.S. and Canadian airlines. An Economic Analyst provides analyticalsupport in collecti...

Overview At Orange County Government, we are proud to serve the public with integrity, honesty, fairness and professionalism. We develop innovative policies and services that impact the Central Florida and shape the future of our community. We have been consistently recognized as a “Top 100 Family Friendly Company” because we facilitate a healthy balance for employees between public service, care...

ABA Clinical Supervisor - BCBA/LCSW/LMFT Competitive Salary PLUS Bonus Plan. JOIN A WINNING TEAM! WILL TRAIN! Description ORGANIZATION The Center for Autism and Related Disorders, Inc. (CARD) is among the world’s largest and most experienced organizations effectively treating children with autism and related disorders. With US and international reach, CARD touches the lives of hundreds of ch...

Qualified Intellectual Disabilities Professional (QIDP) Job Type: Full-time Position Summary: Progressive Housing is looking for a motivated Qualified Intellectual Disabilities Professional to oversee the daily functions in residential homes. Job Duties and Responsibilities: The statements below describe the general nature and level of work being performed in this role. They are not intended ...

Job Description We are currently seeking organized and motivated individuals to join the Aetna Medicare Grievance and Appeal team as a Complaint and Appeal Analyst. Please note that there are multiple opportunities available! In order to be considered for this role, you must be commutable to an Aetna office, and preference will be given to individuals residing near our office locations in Fresno...

Introduction FINAL FILING DATE: FILE IMMEDIATELY Receipt of applications may close at any time, but not before April 28, 2015 by 5:00 PM. This is a Position-Based Test administered in accordance with Civil Service Rule 111A. The current position is located at San Francisco International Airport. The eligible list resulting from this examination may be utilized for future positions in this class...

We are currently seeking organized and motivated individuals to join the Aetna Medicare Grievance and Appeal team as a Complaint and Appeal Analyst. Please note that there are multiple opportunities available! In order to be considered for this role, you must be commutable to an Aetna office, and preference will be given to individuals residing near our office locations in Fresno CA, New Albany O...