8 Grievance Jobs

Job Summary - A career in our Managed Services team will provide you an opportunity to collaborate with a wide array of teams to help our clients implement and operate new capabilities, achieve operational efficiencies, and harness the power of technology. Our Appeals and Grievances Managed Services (AGMS) team will provide you with the opportunity to act as an extension of our healthcare clients' business office. We specialize in appeal and grievances functions and addressing member complaints for health plans and their business partners. We leverage our clients customized workflows and associated automations in conjunction with clients data advanced data analysis and quality assurance processes to enable our clients to achieve better compliant results, which ultimately allows them to provide better services to their members. Required Field of Study (BQ): Any Graduation Minimum Year(s) of Experience : US 2+ years of experience in US Health care Payor side Required Knowledge/Skills (BQ): US Healthcare Experience Experience in Appeals & Grievances (A&G, Medicare/Medicaid) Preferred Knowledge/Skills *: Strong verbal and written communication skills, including letter writing experience. Excellent English skills with the ability to read, comprehend, write and communicate verbally with stakeholders & customers. Ability to work with firm deadlines, multi-task, set priorities and pay attention to details Ability to successfully interact with members, medical professionals, health plan and government representatives. Knowledge on Appeals & Grievances and Medicare/Medicaid Proficiency with Microsoft Word, Excel, and PowerPoint. Excellent organizational, interpersonal and time management skills. Must be detail-oriented and an enthusiastic team player. Knowledge of Pega computer system a plus. Responsibilities: As an Associate, youll work as part of a team of problem solvers with consulting and industry experience, helping our clients solve their complex member, provider and business issues. Specific responsibilities include, but are not limited to: Analyzes, evaluates and resolves member & provider appeals, disputes, grievances, and/or complaints from health plan members, providers and related outside agencies in accordance with the standards and requirements established by the Centers for Medicare and Medicaid and/or health plan. Prepares and organizes case research, notes, and documents. Contacts the member/provider through written and verbal communication. Requests, obtains and reviews medical records, notes, and/or detailed bills as appropriate. Applies contract language, benefits, and review of covered services. Conducts research, fact checking and analysis and recommends appropriate course of action and next steps for management review. Research claim / service authorization appeals and grievances using support systems to determine appeal and grievance outcomes inclusive of claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error. Determines appropriate language for letters and composes all correspondence and appeal/dispute and or grievances information concisely and accurately, in accordance with regulatory requirements. Communicates resolution to members (or authorized) representatives. Works with provider & member services to resolve balance bill issues and other member/provider complaints. Assures timeliness and appropriateness of responses per state, federal and health plan guidelines. Responsible for meeting production standards set by the department. Prepares appeal summaries, correspondence, and document findings. Include information on trends if requested. Desired Knowledge / Skills: 2+ years of experience in US Health care Payor side 1 + years of processing experience in Appeals & Grievance Denial Management Knowledge on US Health Care, Claims Adjudication, Rework & A&G Experience Level: 2+ years Shift timings: Flexible to work in night shifts (US Time zone)

Role & responsibilities Responsible for managing client servicing with key decision makers Addresses the gaps identified between client requirement & the service provided Ensure that the service is delivered in accordance with the agreed service level agreement Act as a point of contact for any escalation or feedback from clients Manage account renewal, customer support escalation Good Communication Skills Good knowledge of MS Office Open to travel Interested share their CV on 7058096238

Role Overview: The Employee Relations Lead will be responsible for developing, implementing, and managing employee relations strategies, policies, and programs. This role will serve as a key point of contact for employees and management on all employee relations matters, ensuring fair and consistent application of company policies and compliance with labor laws. The ideal candidate will be a proactive problem-solver with excellent communication and interpersonal skills, capable of building trust and resolving conflicts effectively. Key Responsibilities: Conflict Resolution & Grievance Management: Lead and conduct investigations into employee grievances, complaints, and disciplinary matters, including allegations of harassment, discrimination, and misconduct, ensuring fairness, thoroughness, and confidentiality. Mediate and resolve workplace disputes, fostering positive employee-employer relationships. Provide guidance and support to managers on performance management, disciplinary actions, and termination processes. Policy Development & Implementation: Develop, update, and interpret HR policies and procedures to ensure compliance with relevant labor laws (e.g., Industrial Disputes Act, Factories Act, POSH Act) and company guidelines. Communicate policies effectively to employees and management, ensuring understanding and adherence. Compliance & Legal Adherence: Stay abreast of changes in Indian labor laws and regulations, ensuring company practices remain compliant. Prepare and maintain accurate documentation related to employee relations cases and investigations. Assist in responding to legal inquiries and preparing necessary documentation for legal proceedings related to employee relations. Employee Engagement & Culture: Contribute to initiatives that promote a positive organizational culture, employee engagement, and a harmonious work environment. Educate employees and managers on best practices for effective communication and conflict prevention. Identify trends in employee relations issues and recommend proactive solutions to improve employee satisfaction and retention. Stakeholder Collaboration: Collaborate closely with HR Business Partners, Legal, and other departments to ensure a cohesive approach to employee relations. Serve as an advisor to senior leadership on employee relations matters and potential risks. Qualifications: Master's degree in Human Resources, Business Administration, Law, or a related field. (MBA-HR preferred) 2-7 years of progressive experience in Employee Relations, with a strong focus on conflict resolution, investigations, and policy development. In-depth knowledge of Indian labor laws and regulations (e.g., Industrial Disputes Act, Factories Act, Payment of Wages Act, PF & ESI, POSH Act). Proven experience in conducting thorough and unbiased workplace investigations. Excellent written and verbal communication skills, with the ability to articulate complex information clearly and concisely. Strong interpersonal skills with the ability to build rapport, influence, and negotiate effectively across all levels of the organization. Demonstrated ability to handle sensitive and confidential information with discretion and integrity. Strong analytical and problem-solving abilities. Certifications in HR or Employee Relations are a plus. Why Join Radical Minds? Opportunity to make a significant impact in a fast-paced and growing organization. Collaborative and supportive work environment. Focus on employee well-being and professional development. Competitive compensation and benefits package. Be part of a company that values innovation and its people. How to Apply: Interested candidates are invited to apply through Naukri with their updated resume and a cover letter detailing their relevant experience and why they are a good fit for this role. You can also send ur CV to: manjula.t@radicalminds.net

Handle IRDA complaints, PMO IGMS, Branches, call centre/e-mail/chat, customer walk ins & Sr. Mgmt escalations SLA's, TAT's, Productivity & Quality metrics, Monitor quality of responses Improve customers connect, provide resolution Required Candidate profile service interactions dealt with promptly including service recovery Good written & verbal communication skills, Exp into customer service or grievance handling role must,Good in Excel Perks and benefits mail resume to vandanacareers228@gmail.com

Provides forward thinking HR consultation on strategic and operational issues by proactively assessing work environment, culture, and identifying and implementing appropriate action. This may include developing and implementing programs in the areas of talent development, rewards/recognition, employee engagement or other initiatives to improve overall organization health and performance. Serves as the primary point of contact for employees and managers in the areas of employee relations, employee development, performance management, compensation, benefits, payroll, and policy/procedure related issues. Supports the annual salary and bonus planning process and provides input into the development of the annual Talent Plan. Provides employee and manager training including Performance, Planning and Development, Employee Engagement, Talent Assessment and Succession Planning and Leadership Development. Participates and/or leads Talent council meetings and supports talent initiatives across the function. Provides HR related data and reporting to leaders to promote data driven decision making and strategy development. Participates in corporate-wide HR service delivery improvement projects. Partners with Talent Acquisition Specialists to ensure the organizations recruiting needs are fulfilled.

Academic batches are run smoothly on a daily basis. Allotting batches to students. batch formation and coordination, aculty coordination, classroom arrangement. Grievance handling.

Manpower Management Compliance Management Grievance Handling Preparation of all Contractor attendance & Verification of all the contractor bills. Co-operation with Employees for EPF & ESI related issues and new joiners’ enrollment.

We are hiring!! HR Recruiter: Arun Kumar Industry: ITES/BPO Category: International Non-Voice Division: Healthcare International Business We are looking for enthusiastic candidates with excellent communication to join our team as Customer Support Associates in the International Non-Voice Process for Healthcare. Job Title: CSA and Senior CSA Grade: H1/H2 Function/Department: Operations Reporting to: Team Lead Role Description: Roles & Responsibilities (Indicative not exhaustive) A claims examiner needs to analyse multiple documents / contracts and decide to pay / deny the claim submitted by member or providers with respect to client specifications. The claims examiner should also route the claim to different department or provider / member for any missing information that required for claims adjudication. The claims needs to be completed adhering to required TAT and quality SLA. Key Results Production, Quality Shift and Schedule adherence Process Knowledge Minimum Eligibility: Candidates should have minimum 1 year Experience in Claims Adjudication & Claims Adjustment or Claims Adjudication with Appeals & Grievances. Shift Details: Night shift / Flexible to work in any shift and timing Cab Boundary Limit: Up to 30 km (One way drop cab) Job Location: Firstsource Solution Limited, 5th floor ETA Techno Park, Block 4, 33 OMR Navallur, Chennai, Tamil Nadu 603103. Landmark near Vivira Mall. Contact: Arun HR Phone: 6374232238 Email: arun.kumar9@firstsource.com If you are interested please share your updated CV to the arun.kumar9@firstsource.com or 6374232238. Join us to be part of a dynamic team with career growth opportunities. We look forward to seeing you at the interview! You can refer your friends as well! Disclaimer: Firstsource follows a fair, transparent, and merit-based hiring process. We never ask for money at any stage. Beware of fraudulent offers and always verify through our official channels or arun.kumar9@firstsource.com