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South Texas Health System

DENISON, Texas

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Optum

Springfield, Massachusetts

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CHRISTUS Health

Texarkana, Texas

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Baylor Scott & White Health

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Raleigh, North Carolina

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Baylor Scott & White Health

University Park, Texas

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Nashville, Tennessee

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Sutter Health Greater Central Valley

Modesto, California

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Everett, Washington

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Southern California Permanente Medical Group

Lancaster, California

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Southern California Permanente Medical Group

Los Angeles, California

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Beebe Healthcare

Lewes, Delaware

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Harris Health System

Houston, Texas

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Southern California Permanente Medical Group

Los Angeles, California

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Appeals and Grievance Specialist Lead
DescriptionSummary:Responsible for reviewing and resolving critical and urgent inquiries including complaints received directly from members, providers, authorized representatives, Government Agencies, Regulatory and the Better Business Bureau. This position will specifically be responsible for handling issues dealing with complicated and/or technical nature. Prepare, analyze, and process expedited provider and member complaints, appeals, and claim disputes for all lines of business within timelines set by regulators. Ensure customer satisfaction and help establish best practices. Handle complex escalated issues and concerns for all lines of business. Interface with other departments or members and providers through written


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