Appeals & Disputes Specialist II

Centene Management Company LLC; Illinois; Hybrid; USD 25.000 - 33.000; Vollzeit

Benefits dieser Stelle

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work with remote, hybrid, or

office work schedules

Zusammenfassung

Centene Management Company LLC seeks a detail‑oriented professional to support documentation and processing of appeals, disputes and reconsiderations, ensuring NCQA compliance. The role involves data entry, preparing correspondence, and maintaining case files to drive timely decisions.

You will assist in researching and resolving requests, tracking trends, and coordinating follow-up with teams. A High School diploma and 1–2 years related experience are required, with opportunities for remote or

Qualifikationen

• High School diploma or GED required.
• 1–2 years of related experience preferred.
• Knowledge of appeals, disputes and reconsiderations process preferred.

Aufgaben

• Document and process appeals, disputes and reconsiderations per state and NCQA requirements.
• Support timely review and processing of cases by the team.
• Enter data to track, log and process cases per regulatory guidelines.
• Prepare correspondence and maintain case documentation files.
• Review and investigate requests to determine follow-up actions.
• Conduct research to evaluate and respond to appeals in a timely manner.
• Assemble case files with supporting documentation for review and reporting.
• Gather data to track trends and outcomes and communicate updates to the team.
• Perform additional duties as assigned and ensure policy compliance.

Kenntnisse

Data entry

Documentation

Regulatory knowledge

Research

Communication

Team support

Ausbildung

High School diploma or GED

Jobbeschreibung

Centene Management Company LLC seeks a detail‑oriented professional to support documentation and processing of appeals, disputes and reconsiderations, ensuring NCQA compliance. The role involves data entry, preparing correspondence, and maintaining case files to drive timely decisions.

You will assist in researching and resolving requests, tracking trends, and coordinating follow-up with teams. A High School diploma and 1–2 years related experience are required, with opportunities for remote or