Grievance & Appeals Coordinator I

Centene Corp.; EE. UU.; A distancia; USD 27.000 - 45.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible remote/hybrid/field or office

Descripción de la vacante

Centene Corp. is seeking a Grievances and Appeals Specialist to analyze verbal and written member and provider complaints, grievances and appeals and help resolve formal grievances.

This remote position requires Kansas residency, with a Monday–Friday schedule 8am–5pm after training. Responsibilities include data entry, preparing response letters, coordinating committees, and supporting HEDIS and pay-for-performance programs.

Formación

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

Responsabilidades

• 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

Educación

High school diploma or equivalent

Associate’s degree preferred

Descripción del empleo

Position Purpose

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

Key Details

Applicants for this remote role must reside in Kansas. The work schedule is Monday – Friday, 8am – 5pm with some flexibility possible once fully trained.

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.

Pay Range

$19.43 - $32.98 per hour

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.

Equal Opportunity & Diversity

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.

About Us

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.