Grievance & Appeals Case Analyst
Digitailor
Commission on Medical Care · US-CA-Fairfield | US-CA-Redding | US-CA-Eureka | US-CA-Chico This posting does not mention sponsorship either way. Commission on Medical Care has 34 certified H-1B filings on record with the US Department of Labor. That is the employer’s history, not a statement about this job. Represents Partnership in the Grievance & Appeals Resolution process. Responsible for reviewing, investigating, and resolving assigned member grievance and appeal cases ranging from low to high complexity. Works to transform member dissatisfaction into member satisfaction. Oversees the investigative process ensuring casework complies with DHCS guidelines, NCQA standards, #J-18808-Ljbffr Digitailor
- Commission on Medical Care in California is seeking a Grievance & Appeals Investigator to review, investigate, and resolve member grievance and appeal cases ranging from low to high complexity in Fairfield, Redding, Eureka, and Chico. You will transform member dissatisfaction...Suggested
- ...Pacific Standard Time hours. You will facilitate medical necessity grievances, appeals, and denials, review clinical data, and determine if criteria... ...include overturning denials when appropriate, preparing case reviews for the Medical Director, coordinating with providers...SuggestedRemote job
$4,176 - $6,790 per month
...Under the general supervision of the Correctional Case Records Supervisor, the Correctional Case Records Analyst (CCRA) is responsible for calculating and modifying... .... Candidates who have been withheld may file an appeal with the State Personnel Board. Applicants who completed...SuggestedPermanent employmentFull timeWork at officeRemote work- ...leading healthcare staffing firm is seeking a detail-oriented individual for managing medical necessity appeals and claims reviews. The role involves reviewing cases, preparing documentation for the Medical Director, and ensuring compliance with NCQA guidelines. Candidates...Suggested
$71.4k - $149.5k
...Senior Financial Analyst - Business Cases The Senior Financial Analyst - Business Cases evaluates strategic investments, business cases, mergers and acquisitions, and other growth opportunities proposed across the enterprise. The analyst will perform financial modeling...SuggestedFull timeWork at office3 days per week1 day per week- California Correctional Health Care Services is hiring Analyst I/II for Mule Creek State Prison in Ione, CA. These roles support health care appeals, data tracking, and reporting to improve program delivery. Positions are 12-month limited term, in-office with potential...Work at office
- ...Relations Manager II, the Labor Relations Analyst (LRA) performs analytical work in... ...program. The LRA assists with research, case tracking, grievance support, training development, and the... ...who have been withheld may file an appeal with the California Department of Human...Permanent employmentFull timeWork at officeLocal areaRemote workVisa sponsorshipWork visa
$6,146 - $7,698 per month
A governmental agency in California is seeking a Legal Analyst who will provide paralegal support for the Appeals Division. Responsibilities include assisting administrative law judges and managing conflicting schedules. This full-time position offers a hybrid work model...Full time2 days per week$71.4k - $149.5k
The Senior Financial Analyst - Business Cases evaluates strategic investments, business cases, mergers and acquisitions, and other growth opportunities proposed across the enterprise. The analyst will perform financial modeling, investment analysis, benchmarking, and scenario...Work at officeLocal areaVisa sponsorshipWork visa3 days per week1 day per week- CA Department of Corrections & Rehabilitation seeks a Correctional Case Records Analyst to manage and adjust release and discharge dates for inmates in accordance with laws and sentences. The role involves interpreting complex directives, processing and maintaining inmate...Work at office
- ...as they are not used to a desk job and no patient interaction. This person will be reviewing cases to make sure the correct medical actions were taken and denying and appealing those cases. They will be writing letters and correspondence and sitting at a computer all...Private practiceWork at office
- ...experience in producing the following documents: data verification & validation requirements, data validation strategy, data validation test cases, and data validation reports. 5. At least two (2) years of experience handling Database Administrator (DBA) tasks using MS SQL...Full time
- QA Assurance Analyst, Large complex enterprise environment exposure essential, Manual & Automation, Downtown Los Angeles An exciting opportunity... ...Develop and execute comprehensive test plans, test cases and testing strategies. Perform manual testing (80%) and automated...3 days per week
- ...manages all applications and next steps. Our partner is looking for a Case Manager - Utilization Review Specialist based in the United... ..., identify potential reimbursement denials, and coordinate appeals to support appropriate patient care and financial performance. You...Full timeLive inRemote work
- ...systems to meet program needs. Ability to analyze requirements gathered and produce documentations including but not limited to use cases, business rules, report specifications, and test cases. Ability to prepare presentation and demoing system functionality to...Work at office
$55 - $64 per hour
## Legal Systems Business Analyst**Remote,CA93013**Employment Type:ContractJob Number: 25971Remote Options: Remote## Job DescriptionLegal... ...with our legal team to translate complex contracting and AI use cases into documented technical specifications and functional workflow...Hourly payContract workRemote work- The Labor Relations Analyst role at the California Department of Developmental Services is based in Sacramento County with hybrid... ...will support the labor relations program through research, case tracking, grievance support, and the development of training materials,...Remote work
- Aventiv is seeking an Intelligence Analyst to build actionable insights for agencies and correctional partners. You will analyze data, produce... ...analysis, deep dives into data sources, and creating PowerPoint case studies to convey trends and recommendations to field teams. #J...
- ...lives of people around the globe. Job Summary The Sales Operations Analyst, Commercial Systems & Enablement will support the commercial... ...performance, pipeline health, account activity, quota attainment, case volume, therapy development activity, and territory performance....
- Join to apply for the Data Analyst role at California Department of Health Care Access and Information Get AI-powered advice on this... ...for the position. Applicants who have been withheld may file an appeal with the State Personnel Board. Application Instructions Completed...Permanent employmentFull timeWork at officeRemote work
- ...effectively. Qualifications: 5+ years of experience as a Business Analyst, with increasing responsibility in project coordination, process... .... Expertise in requirements elicitation, gap analysis, use case documentation, and process modeling Strong understanding of...
$90.8k - $136.2k
...continue to align their platforms. ~ Comfortable working with AI tools day to day — using them to speed up requirements drafting, test case generation, data analysis, and research, while still applying your own judgment to the output. Certain states and localities...Full timeFlexible hoursShift work- ...Professional Business Analyst We are seeking a Professional Business Analyst to work closely with product, technical, and business teams... ...a strong understanding of the platform and its healthcare use cases. Required Skills & Experience: Create, update, and...
- Position Summary The Information Technology Business/Technical Analyst I is an experienced, senior-level technical or business specialist... ...for technical design. Creates functional requirements in use cases; coordinates requirements walk-through and sign-offs, verifies with...Full timePart time
$5,237 - $5,513 per month
...Employee Relations and supervised by the Senior Analyst, the Employee/Labor Relations Analyst... ...research, analysis and preparation of grievance and complaint responses. In addition, the... ...requests related to grievances and discipline cases. Research and summarize current issues...Contract workWork experience placementWork at officeLocal areaImmediate start$40 - $45 per hour
...IT Business Analyst Under limited general direction, the Business Analyst is responsible for bridging the gap between IT and the business... ...elicitation techniques. Proven ability to build businesses cases that solve business and technical challenges that are supported...Hourly payWork at officeRemote work3 days per week$80k - $128k
...Business Analyst Peraton serves as a valued partner to essential government agencies across the intelligence, space, cyber, defense,... ...Business Requirements Documents (BRDs), process flow diagrams, use cases, and standard operating procedures (SOPs). Conduct gap...Contract workLocal areaShift work- ...Vscore Inc. in Sacramento, CA seeks an experienced Business Analyst to drive cross-functional projects from ideation to implementation. You will gather requirements, document use cases, and model processes to align stakeholders and deliverables. You will apply SDLC and...
- The Disability Consultant (Analyst I) at the California Department of Public Health supports employees, supervisors, and managers with disability... ...I, SDI, parental leave, and other leaves, plus guidance on WC case management and return-to-work. Compliance with ADA, Cal/OSHA,...
- ...Department of Public Health in Sacramento County seeks a Senior Disability Consultant to manage disability leave entitlements and complex case work. You will provide guidance on FMLA/CFRA, ND I, SDI, and leave of absence programs, and support the RA and WC processes. The...
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