Top 24859 Complete Recruiting Solutions Jobs

Grievance Resolution Specialist
Kinetic Personnel Group, Inc. —Orange, CA
- $25 - $37 an hour
- Temporary
- Spanish
- Microsoft Outlook
- Writing skills
- Paid time off
- Paid sick time
Quick Apply
12d
Sr. Acquisition Support Specialist
Design To Delivery Inc —Remote
- $45 - $60 an hour
- Full-time
- Remote
- Microsoft Outlook
- Data analysis skills
- Finance
- Paid holidays
- Disability insurance
Quick Apply
Government Contracting Consultant (Remote) High-Ticket Sales | Warm Leads | Google Meet Consultation
Landmark Federal Solutions LLC —Remote
- $4,000 - $11,000 a month
- Part-time
- Remote
- Mentoring
- Recruiting
- In-person
- Professional development assistance
- Opportunities for advancement
Quick Apply
4d
Training Specialist
Management Solutions LLC —Remote
- Full-time
- Remote
- Mid-level
- Continuous improvement
- US work authorization
Recruiter
Wilderness Medical Staffing —Remote
- $70,000 - $80,000 a year
- Online Application
- Remote
- Customer service
- Mid-level
- Analysis skills
- Profit sharing
- Health insurance
14d
General Interest Application
KPA —Remote
- Remote
- Office
- US work authorization
- Entry level
- Paid holidays
- Health insurance
Operations Associate - Recruiting, Compliance, Administrative
Erias Ventures LLC —Maryland
- $65,000 - $90,000 a year
- Part-time
- Remote
- Google Workspace
- Microsoft Excel
- Bachelor's degree
- Health savings account
- Disability insurance
Quick Apply
Digital Solutions Manager (Recruiting Tech & Learning Platforms)
Okta —Bellevue, WA
- $148,000 - $203,500 a year
- Hybrid work
- Fair chance
- Senior level
- Leadership
Quick Apply
BPO AI Solutions Architect
Resolv.Global —Remote
- Full-time
- Remote
- English
- APIs
- Senior level
Quick Apply
Talent Development - Employee Onboarding Specialist
X energy LLC —Rockville, MD
- $100,000 - $130,000 a year
- Full-time
- 8 years
- High school diploma or GED
- Bachelor's degree
- Disability insurance
- Health insurance
Licensed Addiction Counselor (Part-time)
ADAMS AND ASSOCIATES INC —Indianapolis, IN
- $23.07 an hour
- Part-time
- Addiction Medicine
- Writing skills
- HIPAA
Quick Apply
11d
Regional Director of Nursing Operations (Remote- Travel required)
ClearSky Health Acquisition, LLC —Albuquerque, NM
- CPR Certification
- Nursing
- Clean driving record
Quick Apply
Freight Broker
Sibley Transportation, Inc. —Bangor, ME
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Ability to walk for extended periods
- Health savings account
- Health insurance
Quick Apply
RN - Operations Educator Supervisor
El Rio Community Health Center —Tucson, AZ
- $34.16 - $49.47 an hour
- Full-time
- Spanish
- Nursing
- Management
Quick Apply
RN
ADAMS AND ASSOCIATES INC —Lopez, PA
- $66,105 a year
- Full-time
- Nursing
- RN License
- HIPAA
- Health insurance
Quick Apply
Registered Nurse (RN)
Center for Human Services —Sedalia, MO
- $29.87 an hour
- Full-time
- CPR Certification
- Nursing
- RN License
Quick Apply
Special Education Teacher
Onward Education —Surprise, AZ
- $50 - $58 an hour
- 8 hour shift
- Classroom
- 18 years or older
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Clinical Pharmacist
Potomac Healthcare Solutions —Portsmouth, VA
- Full-time
- Military
- Mid-level
- Outpatient experience
- Wellness program
- Health savings account
Quick Apply
Process Project Engineer
Bel Group —Nampa, ID
- Construction site
- Engineering
- Office
Special Education Teacher
Onward Education —Boulder, CO
- $48 - $52 an hour
- Full-time
- School experience
- 18 years or older
- Spanish
- Health insurance
- Dental insurance
Quick Apply

I want to receive the latest job alert for Complete Recruiting Solutions

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

Complete Recruiting Solutions jobs near

Grievance Resolution Specialist

Kinetic Personnel Group, Inc. -
Orange, CA

Quick Apply

Job Details

Temporary
$25 - $37 an hour
12 days ago

Benefits

Paid time off
Paid sick time

Qualifications

Employee relationship building
High school diploma or GED

Full Job Description

Kinetic Personnel Group is currently recruiting for a Grievance Resolution Specialist for a Public Health Agency (government entity). This position will be based in Orange County. This 3 billion-dollar a year government public agency is renowned for its work in the community and being a great place to work.

The Grievance Resolution Specialist coordinates the Grievance and Appeal resolution process, responds to verbal and written Grievances and Appeals from members and/or providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions, and pharmacy and vision decisions. The incumbent has frequent external contact with members and families, healthcare providers, health networks, third-party administrators, and regulators. The incumbent collaborates with internal departments such as Customer Service, Provider Operations, Pharmacy, and Medical Management to identify factors necessary for the optimal resolution of Grievances and Appeals.

This position is a 6 month temporary position (in-office, onsite) that pays between $25/hr - $37/hr depending on experience. This will become a permanent position for the right candidate.

A full time permanent position includes a pay raise, telecommute options, a CalPERS Pension and excellent government benefits including generous holiday, PTO and sick pay days off, year one!

Job duties:

Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
Maintains adequate information in company’s Health’s systems; ensures data collection, summarization, integration, and reporting which includes case creation and management and events/activity tracking.
Gathers pertinent information regarding the grievances and appeals received, including, but not limited to, member or provider concerns, supporting information related to initial decision-making, new information supporting the grievance or appeal, or supplemental information required to evaluate grievances and appeals within regulatory requirements.
Coordinates and/or participates in case discussion with operational experts to result in a final case disposition as needed.
Evaluates case details, proposes recommendations, or makes decisions as applicable; ensures organization decision is implemented according to the Grievance and Appeals policies and case resolution.
Develops resolution letters and correspondence to members and providers.
Communicates with internal and external customers to ensure timely review and resolution of grievances or appeals.
Initiates referrals to Quality Improvement department as applicable and facilitates responses to members according to company Health policy.
Assists with Health Networks’ compliance process.
Identifies trends and root cause of issues; proposes solutions or escalates ongoing issues to management.
Meets performance measurement goals for Grievance and Appeals Resolution Services.
Completes other projects and duties as assigned.
Exercise discretion in processing confidential information.
Identify critical issues and make recommendations or decisions by using critical thinking skills.
Document and present case research findings and formulate resolution letters.
Communicate clearly and concisely both, orally and in writing.
Establish and maintain effective working relationships with company Health’s leadership and staff.
Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Requirements:

High School diploma or equivalent required. (Associates degree preferred)
1 year of experience in any of the following areas: Grievances and Appeals, Claims, Regulatory Compliance, Customer Service, or related fields required.
Managed Care industry, health care, Medi-Cal/Medicaid, and Medicare processes.
An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.
1 year of Provider Dispute Resolution experience highly preferred
Bilingual in English and in one of company’s Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese) preferred.
Appeals and Grievances operating procedures and processes strongly preferred.

KPG123

Quick Apply

Refine Your Search

Complete Recruiting Solutions jobs

Grievance Resolution Specialist

Sr. Acquisition Support Specialist

Government Contracting Consultant (Remote) High-Ticket Sales | Warm Leads | Google Meet Consultation

Training Specialist

Recruiter

General Interest Application

Operations Associate - Recruiting, Compliance, Administrative

Digital Solutions Manager (Recruiting Tech & Learning Platforms)

BPO AI Solutions Architect

Talent Development - Employee Onboarding Specialist

Licensed Addiction Counselor (Part-time)

Regional Director of Nursing Operations (Remote- Travel required)

Freight Broker

RN - Operations Educator Supervisor

RN

Registered Nurse (RN)

Special Education Teacher

Clinical Pharmacist

Process Project Engineer

Special Education Teacher

I want to receive the latest job alert for Complete Recruiting Solutions

Related Searches

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected