Grievance & Appeals Specialist I — Remote

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

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.