Grievance & Appeals Coordinator I — Remote (CA)

Centene Corp.; Woodland (CA); Hybrid; USD 55,655,000 - 95,054,000; Full time

Job summary

Centene Corp. is seeking a Grievance & Appeals Coordinator I to analyze and resolve verbal and written claims and appeals from providers and members and to support related committees. This role is remote-CA with full-time status and requires near Woodland Hills, CA or ability to reside nearby.

You will gather, analyze and report complaints, prepare response letters, maintain files, and assist with HEDIS and pay-for-performance initiatives. The position offers a competitive pay range and benefits.

Qualifications

• High school diploma or equivalent; associate's degree preferred.
• 2+ years of grievance or appeals, claims, or related managed care experience.
• Must reside near Woodland Hills, CA and be authorized to work in the U.S.

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 pay-for-performance programs, including data entry, tracking, organizing, and researching information
• Assist with HEDIS production functions including data entry, calls to provider offices, and claims research
• Manage large volumes of documents including copying, faxing and scanning incoming mail
• Performs other duties as assigned

Skills

Grievance handling

Appeals processing

Education

High School Diploma

Associate's degree preferred

Job description

Centene Corp. is seeking a Grievance & Appeals Coordinator I to analyze and resolve verbal and written claims and appeals from providers and members and to support related committees. This role is remote-CA with full-time status and requires near Woodland Hills, CA or ability to reside nearby.

You will gather, analyze and report complaints, prepare response letters, maintain files, and assist with HEDIS and pay-for-performance initiatives. The position offers a competitive pay range and benefits.