Remote Grievance & Appeals Coordinator II

Centene Corp.; United States; Remote; USD 32,000 - 55,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work schedules (remote / hyb/

Remote or office work arrangements

Job summary

Centene Corp. is seeking a remote Grievance & Appeals Coordinator II to analyze and resolve member and provider grievances and appeals, and to manage inquiries under federal, state, and internal regulations.

The role emphasizes collaboration with Pharmacy Services teams and health plan partners, requires a bachelor’s degree and 2+ years of managed care experience, and offers comprehensive benefits and flexible remote/hybrid schedules.

Qualifications

• Bachelor’s degree in related field or equivalent experience.
• 2+ years of claims, contracting, or related experience in a managed care environment.
• Strong written and oral communication skills for collaboration.

Responsibilities

• Review and process member and provider grievances and appeals within regulations and policies.
• Review claim grievance for reconsideration and determine approval/denial or prepare for medical review.
• Prepare cases for medical review as necessary.
• Review for potential quality or access issues in grievances.
• Collaborate with subject matter experts for opinions on complex cases.
• Serve as liaison between member, provider regulators and internal staff.
• Correspond with key individuals regarding grievance and appeal decisions.
• Act as subject matter expert regarding grievances and appeals.
• Lead Appeals and Grievance Committee.
• Perform other duties as assigned.
• Comply with all policies and standards.

Skills

Grievance resolution

Claims analysis

Verbal communication

Written communication

Education

Bachelor's degree in related field

Job description

Centene Corp. is seeking a remote Grievance & Appeals Coordinator II to analyze and resolve member and provider grievances and appeals, and to manage inquiries under federal, state, and internal regulations.

The role emphasizes collaboration with Pharmacy Services teams and health plan partners, requires a bachelor’s degree and 2+ years of managed care experience, and offers comprehensive benefits and flexible remote/hybrid schedules.