Grievance & Appeals Coordinator I

Centene Management Company LLC; California (MO); Hybrid; USD 27,000 - 45,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K plans

Tuition reimbursement

Paid time off

Flexible schedules

Job summary

Centene Management Company LLC is seeking a detail-oriented professional to analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of grievances from members. Must be authorized to work in the U.S.

without visa sponsorship; candidates should reside near Woodland Hills, CA. The role involves gathering and reporting complaints, preparing response letters, maintaining case files, and supporting committees.

Qualifications

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

Responsibilities

• 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.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Verbal communication

Written communication

Data entry

Claims research

Education

High school diploma or equivalent

Associate’s degree preferred

Tools

HEDIS data systems

Document management software

Job description

Position Purpose and Key Details

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

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. Candidates must reside near Woodland Hills, CA.

• 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
• Performs other duties as assigned
• Complies with all policies and standards

Education and Experience

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

Pay Range

Pay Range: $19.43 - $32.98 per hour

Company and Culture

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
• 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.

Equal Opportunity

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.