Senior Member Escalations & Grievances Specialist
Foodsmart
Foodsmart is seeking a seasoned member escalations specialist who can own complex grievances end-to-end, working with members, health plans, and internal teams. The role requires clear, compassionate communication and strong judgment to de-escalate high-stakes situations. You will translate complex issues into actionable insights, coordinate with Clinical Operations, engineering, and product teams, and ensure compliant, well-documented resolutions. #J-18808-Ljbffr
- MJHS in New York, NY seeks an A&G Coordinator to investigate and respond to member and provider appeals and grievances under CMS and DOH rules. In a non-clinical role, you will help ensure timely decisions and accurate documentation. You will determine the appropriate...Suggested
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JOB DESCRIPTION Job Summary Provides senior level support for clinical quality member intervention activities. Responsible for the developing and implementing new and existing member intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid...SeniorRemote jobWork experience placementWork at officeNight shift- Senior Specialist, Digital Asset OperationsAt BNY, our culture allows us to run our company better... ....We’re seeking a future team member for the role of Senior Associate to join... ...monitoring queues, resolving breaks, and escalating issues as needed.Identifying operational...SeniorWork at officeWorldwideFlexible hoursAfternoon shift
$208.29k - $312.44k
...field teams, partners, and senior customer stakeholders. Advise... ...technical leadership to Solutions Specialists, Sales Engineers, solution... ...high-priority customer escalations involving architecture, product... ...work done - from anywhere. Members of our team will tell you...SeniorLocal area- ...9000Base Salary Max: 114000We’re seeking a future team member for the role of Senior Specialist, Real Estate Lending to join our Credit Services team.... ...indicators.Track regulatory reporting and internal controls; escalate exceptions and propose remediation plans.Client...SeniorFull timeWork experience placementInterim roleWorldwideFlexible hours
- ...with regulatory and internal policy requirements.Identify and escalate operational, compliance, documentation, and fraud risks.Serve as... ...personal resilience, and reach your financial goals as a valued member of our team, along with generous paid leaves, including paid...SeniorWork experience placementWork at officeWorldwideFlexible hours
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...Job Title: Senior Specialist, External Quality Operations Requisition: JR000016029 Location(s): Bridgewater, NJ... ...counterparts at the CMO and cross-functional team members. The position is responsible for appropriate escalation to Manager/Director level management and above....SeniorWork at officeRemote work$95k - $105k
...extensive collaboration across our international team. As a senior member of the team, you will independently manage study and site... ...proactively managing risks and mitigations with responsibility for escalation of concerns, safety management plans, risk-based quality...SeniorPermanent employmentFull timeContract workTemporary workWork at officeLocal areaWork from homeFlexible hours- Senior Specialist, T2 (Target2) Payment Operations We're moving from indirect to direct participation... ...process around DNB, FIS and TARGET escalation routes, own Payment Ops' role in DNB... ...opportunity is available to every team member, from junior team members to our founders...SeniorRemote work
$67.81k - $80k
...Hi, we’re Oscar. We’re hiring a Senior Specialist, Issue Management to join our Network Operations... ...and a relentless focus on serving our members. We started Oscar in 2012 to create... ...respond to and resolve issues/errors/escalations through investigation to inform insights...SeniorFull timeTemporary workWork at officeRemote workShift work$102.6k - $138.5k
...approvals, notifications, condition rules, routing logic, and escalations. Analyze and improve HR, Talent, Recruiting, Compensation,... ...University's Statement of Non-Discrimination policy and related grievance procedures, click here. To report questions or concerns about...SeniorLocal area- Senior Country Approval Specialist Join Us as a Senior Country Approval Specialist - Make an Impact at the... ...regulatory process of a study, resolve or escalate as appropriate. Education &... ...required Ability to mentor fellow SIA team members in a positive and effective manner...SeniorContract workWork at officeLocal area
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$18 - $21 per hour
Senior Verifications Specialist The Senior Verifications Specialist performs all verifications functions... ...advanced level, handling complex or escalated custodian contacts, serving as a subject... .... This role supports junior team members and assists leadership in...SeniorWork at officeLocal area- ...maintaining a strong balance sheet. The Senior Accounts Payable Specialist reports to the Accounts Payable... ...and payment exceptions Serve as an escalation point for vendors, field teams, and... ...provide guidance to less experienced team members Onboard new vendors, including...SeniorRemote work
- # Senior Specialist, Client Operations - Investment Account ServicesApply**Job#: 3056164****Job... ...and resolve operational exceptions, escalations, and non-routine client issues while exercising... ...guidance to less experienced team members while contributing to a collaborative...SeniorHourly payContract work
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...an alternative application process. Senior Curative Specialist C2S - Intern 99 US 4 days ago Requisition... ...complex curative matters and escalated title issues. Monitor aging pipelines... ...Specialists and other operational team members. Participate in root cause analysis and...SeniorTemporary workInternship- ...Molina Healthcare is seeking a claims appeals specialist to support member and provider disputes, appeals, and grievances in accordance with CMS standards. The role emphasizes research, documentation, and timely responses. Required experience includes managed care claims...
- ...Molina Healthcare is seeking a detail‑oriented claims professional to support appeals, disputes, grievances, and complaints from members, providers, and external agencies. You will research and resolve issues to ensure timely, compliant outcomes under CMS guidelines. Responsibilities...
- ...support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to... ...Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related...Contract workWork at officeRemote work
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...Overview The AmeriCorps member will possess excellent communication and organizational skills and provide support to young people that... ...housing. Other functions include crisis intervention and de-escalation, documentation in multiple databases, facilitation of educational...Permanent employmentLocal areaShift work- ...Molina Healthcare is seeking a Claims Appeals Specialist to support claims activities, review member and provider complaints, and communicate resolutions in... ...with CMS standards. You will research appeals and grievances, request and review medical records, prepare summaries...Contract work
$225k - $275k
...experienced, board-certified Veterinary Internal Medicine Specialist to join our Internal Medicine Department as a Senior Veterinarian . This opportunity is designed for... ...mentorship to veterinary technicians and other members of the patient care team Contributing to AMC's...SeniorFull timeInternshipRelocation package- ...provides strategic and tactical intelligence impacting member firms, investors, and the financial markets, translating... ...insights through finished intelligence products. The Senior Principal Intelligence Specialist will have extensive knowledge of and expertise in intelligence...SeniorFull timeTemporary workFor contractorsFor subcontractorWork at officeLocal areaImmediate start
- ...Intermediate level position responsible for delivering excellent member experiences by responding to member inquires in a courteous,... ...resources available to ensure service level agreements are met. Escalates concerns when necessary to appropriate individuals in a timely...Immediate startRemote work
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- Yuzu Health is seeking a Member and Provider Experience Specialist to be the first point of contact for members and healthcare providers. You will deliver... ...users on plan policies, digital tools, and resources, escalate when needed, and collaborate across internal teams to...Remote job
- CVS Health is seeking an Appeals/Grievances Specialist to manage intake, investigation, and resolution of appeals, complaints, and grievances... ...benefit language, and timely, customer-focused responses to members and providers. Responsibilities include researching plan design...
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