Grievance & Appeals Coordinator I

Centene Corp.; California; Hybrid; USD 60,000 - 85,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Flexible remote/work schedules

Job summary

Centene is seeking a claims/grievances specialist to analyze and resolve verbal and written claims and appeals from providers, and pursue resolution of member grievances. This remote California-based role requires a background in healthcare, appeals, and/or behavioral health, with potential overtime and weekend work.

The position involves gathering and reporting complaints, preparing response letters, maintaining files, coordinating committees, and supporting data-driven programs including HEDIS

Qualifications

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

Grievances & appeals experience

Healthcare industry knowledge

Education

High school diploma or equivalent

Associate's degree preferred

Job description

Position Purpose

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

Key Details

• This is a remote position requiring candidates to reside in California.
• A background in healthcare, appeals, and/or behavioral health is preferred.
• Overtime and weekend work may be required.

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

Education/Experience

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

Benefits

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.

Equal Opportunity Statement

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

Application Support

Should you need an accommodation, please email [e-mail].

Company Overview

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.