Remote Appeals Specialist (ET Hours)

Centene Corporation; New York (NY); Hybride; USD 28 000 - 48 000; Plein temps

Avantages offerts par ce poste

Health insurance

401K

Stock purchase plans

Tuition reimbursement

Paid time off

Résumé du poste

Centene Corporation is seeking an Appeals Specialist to support the documentation and processing of appeals, disputes and reconsiderations to meet NCQA requirements. This fully remote role is open to candidates anywhere in the U.S. and follows Eastern Time hours (8:30 AM to 5:00 PM ET).

The ideal candidate has 1–2 years of related experience in regulated casework, strong data entry skills, and the ability to manage complex cases in a deadline-driven environment. No license is required.

Qualifications

• Requires a High School diploma or GED.
• Requires 1 – 2 years of related experience.

Responsabilités

• Performs data entry to support tracking, logging, and processing of appeals, disputes and reconsiderations in accordance with guidelines.
• Prepares correspondence for appeals, disputes and reconsiderations and maintains documentation files.
• Reviews and investigates requests to determine applicable follow up.
• Conducts research needed to evaluate, process, and respond to appeals to ensure timely decisions.
• Prepares case files including supporting documentation and determinations needed to review and report.
• Gathers data to track trends and outcomes and communicates updates to the team.
• Complies with all policies and standards.

Connaissances

Data entry

Regulatory knowledge

Communication

Formation

High School diploma or GED

Description du poste

Centene Corporation is seeking an Appeals Specialist to support the documentation and processing of appeals, disputes and reconsiderations to meet NCQA requirements. This fully remote role is open to candidates anywhere in the U.S. and follows Eastern Time hours (8:30 AM to 5:00 PM ET).

The ideal candidate has 1–2 years of related experience in regulated casework, strong data entry skills, and the ability to manage complex cases in a deadline-driven environment. No license is required.