Grievance & Appeals Coordinator I

Oklahoma Complete Health; California (MO); Remote; Full time

Job summary

A leading healthcare organization seeks a Grievance & Appeals Coordinator I to analyze and resolve claims and grievances. This remote position requires strong communication skills and a background in managed care. Join a team committed to improving the experience for millions of members.

Benefits

Health Insurance

401K

Stock Purchase Plans

Tuition Reimbursement

Paid Time Off

Flexible Work Schedules

Qualifications

• 2+ years grievance or appeals, claims or related managed care experience.
• Healthcare grievance and appeals experience strongly preferred.

Responsibilities

• Analyze and resolve verbal and written claims and authorization appeals.
• Gather, analyze and report member and provider complaints.
• Prepare response letters for complaints, grievances, and appeals.

Skills

Problem Solving

Oral Communication

Written Communication

Education

High School Diploma

Associate's Degree

Job description

Grievance & Appeals Coordinator I page is loaded

Grievance & Appeals Coordinator I

Apply locations Woodland Hills-21281 Burbank Boulevard (10511) Remote-CA time type Full time posted on Posted 2 Days Ago time left to apply End Date: May 19, 2025 (13 hours left to apply) job requisition id 1566685

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.

***Remote position. Must reside in California***

2+ years grievance or appeals, claims or related managed care experience.

Healthcare grievance and appeals experience strongly preferred.

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. Total compensation may also include additional forms of incentives.

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