Remote Appeals Specialist - Timely Disputes

Centene Management Company LLC; New York (NY); Ibrido; USD 28.000 - 48.000; Tempo pieno

Descrizione del lavoro

Centene Management Company LLC is seeking a fully remote Appeals Specialist in the United States. The role supports documentation and processing of appeals, disputes and reconsiderations to meet NCQA requirements and timelines.

Working Eastern Time hours, you will handle regulated casework with minimal supervision and ensure timely decisions. Requires a High School diploma or GED and 1–2 years of related experience; knowledge of appeals processes is preferred.

Competenze

• Requires a High School diploma or GED.
• Requires 1–2 years of related experience.
• Knowledge of appeals, disputes and reconsiderations process preferred.

Mansioni

• Performs data entry to support the tracking, logging, and processing of appeals, disputes and reconsiderations in accordance with established regulatory and accreditation guidelines and procedures
• Prepares correspondence for appeals, disputes and reconsiderations and maintains documentation files
• Reviews and investigates appeals, disputes and reconsiderations requests to determine applicable follow up
• Conducts research needed to evaluate, process, and respond to appeals, disputes and reconsiderations to ensure a timely decision
• Prepares case files including supporting documentation and determinations needed to review, process, and report the appeals, disputes and reconsiderations
• Gathers appeals, disputes and reconsiderations data to track and report on trends and final outcomes to team including conducting outreach for an update on statuses, determinations, and explanations
• Performs other duties as assigned
• Complies with all policies and standards

Conoscenze

Data entry

Regulatory knowledge

Time management

Formazione

High School diploma or GED

Descrizione del lavoro

Centene Management Company LLC is seeking a fully remote Appeals Specialist in the United States. The role supports documentation and processing of appeals, disputes and reconsiderations to meet NCQA requirements and timelines.

Working Eastern Time hours, you will handle regulated casework with minimal supervision and ensure timely decisions. Requires a High School diploma or GED and 1–2 years of related experience; knowledge of appeals processes is preferred.