Appeals Specialist II

Centene Management Company LLC; Illinois; Hybrid; USD 25,000 - 33,000; Full time

Benefits offered by this job

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

Job summary

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

Qualifications

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

Responsibilities

• 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.

Skills

Data entry

Documentation

Regulatory knowledge

Research

Communication

Team support

Education

High School diploma or GED

Job description

Position Purpose:

Supports the documentation and processing of appeals, disputes and reconsiderations to ensure they are in accordance with state and National Committee for Quality Assurance (NCQA) requirements. Support the team to ensure appeals, disputes and reconsiderations are reviewed and processed timely.

Key Details:

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Experience with the documentation and processing of No Surprises Act (NSA) Open Negotiation Requests (ONRs), Independent Dispute Resolution (IDR), and/or state healthcare payment disputes, preferred.

Performs data entry to support the tracking, logging, and processing of appeals, disputes and reconsiderations in accordance with established regulatory and accreditation guidelines and procedures.

Prepares correspondence for appeals, disputes and reconsiderations and maintains documentation files.

Reviews and investigates appeals, disputes and reconsiderations requests to determine applicable follow up.

Conducts research needed to evaluate, process, and respond to appeals, disputes and reconsiderations to ensure a timely decision.

Prepares case files including supporting documentation and determinations needed to review, process, and report the appeals, disputes and reconsiderations.

Gathers appeals, disputes and reconsiderations data to track and report on trends and final outcomes to team including conducting outreach for an update on statuses, determinations, and explanations.

Performs other duties as assigned.

Complies with all policies and standards.

Education/Experience:

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

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Benefits:

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• 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.