Grievance & Appeals Program Leader (Healthcare)

Centene Management Company LLC; Arizona; Hybrid; USD 70,000 - 126,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

PTO & holidays

Remote/hybrid/work from office options

Job summary

Centene is seeking a Grievance & Appeals Lead in Arizona to manage processing of member grievances and provider appeals, acting as the state liaison and ensuring regulatory compliance. The role entails guiding cross‑functional teams and delivering monthly trend analyses.

You will oversee day‑to‑day operations, drive process improvements, and train external agencies on grievance procedures. A Bachelor’s degree and 3+ years in healthcare or law are required.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• 3+ years in healthcare/law, grievances and appeals.
• Lead experience with managing cross-functional teams on large projects; supervisory experience including hiring, training and performance management.

Responsibilities

• Process member grievances and provider appeals within contractual timelines.
• Serve as primary contact with State and ensure compliance with legal requirements.
• Provide monthly reporting to senior management on trends in appeals and grievances.
• Train and guide agencies in developing procedures to comply with grievance and appeals requirements.
• Review and process incoming incident/accident reports.

Skills

Grievances & Appeals

Leadership

Project management

Education

Bachelor’s degree or equivalent experience

Job description

Centene is seeking a Grievance & Appeals Lead in Arizona to manage processing of member grievances and provider appeals, acting as the state liaison and ensuring regulatory compliance. The role entails guiding cross‑functional teams and delivering monthly trend analyses.

You will oversee day‑to‑day operations, drive process improvements, and train external agencies on grievance procedures. A Bachelor’s degree and 3+ years in healthcare or law are required.