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Community Medical Centers Inc. Logo
Community Medical Centers Inc.

Stockton, California

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AdventHealth

Maitland, Florida

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Akron Children's Hospital

Akron, Ohio

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MemorialCare Health System

Fountain Valley, California

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AdventHealth

Davenport, Florida

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Duke University Health System

Durham, North Carolina

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Duke University Health System

Durham, North Carolina

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ChristianaCare Health System

Wilmington, Delaware

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AdventHealth

Tarpon Springs, Florida

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AdventHealth

Maitland, Florida

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CHRISTUS Health

Santa Fe, New Mexico

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AdventHealth

Maitland, Florida

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Cincinnati Children's Hospital Medical Center

Cincinnati, Ohio

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Vanderbilt Health

Nashville, Tennessee

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Harris Health System

Houston, Texas

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Memorial Sloan Kettering Cancer Center

New York, New York

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Baylor Scott & White Health

TEMPLE, Texas

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Vanderbilt Health

Nashville, Tennessee

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Kindred Hospitals

Franklin, Tennessee

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AdventHealth

Shawnee Mission, Kansas

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SCL Health

Broomfield, Colorado

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Vanderbilt Health

Nashville, Tennessee

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Appeals and Grievance Specialist
JOB SUMMARYThe Appeals and Grievance Specialist performs reviews, within operational aspects, of the member and provider complaints, appeals and grievance cases for products for all lines of business. Responsibilities include, but are not limited to: timely classification and resolution of cases; review, research and coordination of complaints, grievances, appeals and reconsiderations consistent with statutory and federal regulatory guidelines.ESSENTIAL FUNCTIONS OF THE ROLEMaintains data entry requirements for all complaints, appeals and grievances.Builds case files for each complaint, appeal and grievance, and ensures compliance with organizational and regulatory guid


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