Remote Grievance & Appeals Coordinator (CA)

Centene Corp.; California; Remote; USD 52,000 - 66,000; Full time

Job summary

Centene Corp. is seeking a Grievance & Appeals Coordinator I for a remote California-based role. The position focuses on analyzing and resolving verbal and written claims and appeals from providers, and pursuing resolution of formal grievances from members.

Candidates should have a background in healthcare, appeals, or behavioral health, with 2+ years of related experience preferred. The role may require overtime and weekend work.

Qualifications

• High school diploma or equivalent is required.
• Associate’s degree is preferred for this role.
• 2+ years of grievance or appeals, claims, or related managed care experience are desirable.

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; coordinate the Grievance and Appeals Committee as needed.
• 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.

Skills

Attention to detail

Communication skills

Analytical thinking

Education

High school diploma or equivalent

Associate’s degree preferred

Tools

None

Job description

Centene Corp. is seeking a Grievance & Appeals Coordinator I for a remote California-based role. The position focuses on analyzing and resolving verbal and written claims and appeals from providers, and pursuing resolution of formal grievances from members.

Candidates should have a background in healthcare, appeals, or behavioral health, with 2+ years of related experience preferred. The role may require overtime and weekend work.