Supervisor, Grievance & Appeals

Centene Corporation; Florida; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Remote work flexibility

Job summary

Centene Corp. is seeking a remote Senior Appeals & Grievances supervisor to oversee day-to-day A&G operations across multiple states. The role ensures productivity and quality metrics are met, handles escalated issues, and distributes caseload efficiently.

Requires a Bachelor’s degree and 2+ years of A&G processing experience in healthcare or managed care, with potential for a bonus. Benefits include competitive pay, health insurance, and retirement plans.

Qualifications

• 2+ years of appeals and grievances processing experience in healthcare or managed care setting.

Responsibilities

• Supervise day-to-day operations of the A&G staff and ensure productivity and quality metrics.
• Provide escalation support for complex issues and monitor case load distribution.
• Train and onboard new team members and ensure policy compliance.

Skills

Appeals & Grievances processing

Regulatory updates

Team supervision

Training onboarding

Education

Bachelor’s degree

Job description

Position Purpose:

Supervise the day to day operations of the Appeals and Grievance (A&G) staff and functions within the department ensuring productivity and quality metrics are met. Support the team on escalated or complex issues and monitor and distribute case load.

Key Details:

This position is remote/work from home. The role will support the states of Delaware, Michigan, Ohio, Texas, Illinois and South Carolina for AIP/duals members for the retrospective appeals process. The work schedule core business hours are Monday - Friday 8am - 5pm; however, must be able to work rotational weekends and holidays to meet turnaround time frames. This position is bonus eligible.

• Ensure that the Appeals & Grievance department processes all appeals, grievances and complaints in accordance with standards and the corporation’s policies and procedures
• Serve as a resource to the team regarding escalated or complex issues, process and systems issues, and regulatory updates
• Monitor and distribute team’s case load and ensure adequate coverage
• Monitor and evaluate performance standards and provide daily feedback and guidance of problem resolution
• Identify and develop opportunities for process improvements and work with various departments to ensure problems are corrected to prevent recurrences
• Train and onboard new team members
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience:

Bachelor’s degree in a related field or equivalent experience. 2+ years of appeals and grievances processing experience in a healthcare or managed care setting preferred. Experience in healthcare law preferred. Pay Range: $56,200.00 - $101,000.00 per year

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act