Remote Grievance & Appeals Specialist – CA

Centene Corp.; California; Hybrid; USD 60,000 - 85,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Flexible remote/work schedules

Job summary

Centene is seeking a claims/grievances specialist to analyze and resolve verbal and written claims and appeals from providers, and pursue resolution of member grievances. This remote California-based role requires a background in healthcare, appeals, and/or behavioral health, with potential overtime and weekend work.

The position involves gathering and reporting complaints, preparing response letters, maintaining files, coordinating committees, and supporting data-driven programs including HEDIS

Qualifications

• High school diploma or equivalent.
• Associate's degree preferred.
• 2+ years grievance or appeals, claims, related managed care 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

Grievances & appeals experience

Healthcare industry knowledge

Education

High school diploma or equivalent

Associate's degree preferred

Job description

Centene is seeking a claims/grievances specialist to analyze and resolve verbal and written claims and appeals from providers, and pursue resolution of member grievances. This remote California-based role requires a background in healthcare, appeals, and/or behavioral health, with potential overtime and weekend work.

The position involves gathering and reporting complaints, preparing response letters, maintaining files, coordinating committees, and supporting data-driven programs including HEDIS