Grievance & Appeals Coordinator I

Centene Corporation; Canada; Remote; CAD 30,000 - 60,000; Full time

Job summary

A healthcare organization seeks a clinical professional to manage claims and grievances. The role involves analytical tasks and requires a high school diploma with preferred additional qualifications. Flexible working hours and comprehensive benefits are part of the offering.

Benefits

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Qualifications

• 2+ years grievance or appeals, claims or related managed care experience.
• High school diploma or equivalent required, Associate’s degree preferred.

Responsibilities

• Analyze and resolve claims and authorization appeals from providers.
• Gather, analyze and report member and provider complaints and grievances.
• Prepare response letters for complaints and manage large volumes of documents.

Skills

Oral communication

Written communication

Problem solving

Education

High school diploma or equivalent

Associate’s degree preferred

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

Must reside within the state of California

Hours: 8am-5pm Pacific Standard Time; Monday-Friday.

Weekends and holidays a needed.

Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.

• Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
• Prepare response letters for member and provider complaints, grievances and appeals
• Maintain files on individual appeals and grievances
• May coordinate the Grievance and Appeals Committee
• Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
• Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research.
• Manage large volumes of documents including copying, faxing and scanning incoming mail

Education/Experience: High school diploma or equivalent. Associate’s degree preferred. 2+ years grievance or appeals, claims or related managed care experience. Strong oral, written, and problem solving skills.Pay Range: $19.04 - $32.35 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act