Supervisor, Grievance & Appeals

Centene Management Company LLC; Florida; Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible remote/hybrid work schedules

Job summary

Centene Management Company LLC is seeking a remote Appeals & Grievance supervisor to oversee day-to-day operations, monitor caseloads, and guide a team through escalated issues. The role emphasizes process improvements and staff development within a healthcare-focused environment.

The position requires a bachelor’s degree and 2+ years of appeals processing experience in healthcare or managed care, with healthcare law exposure preferred.

Qualifications

• 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.

Responsibilities

• Supervise day-to-day operations of the Appeals & Grievance staff and ensure productivity and quality metrics are met.
• Support the team on escalated or complex issues and monitor and distribute caseload.
• Monitor and evaluate performance standards and provide daily feedback and guidance on problem resolution.
• Identify and develop opportunities for process improvements and work with various departments to prevent recurrences.
• Train and onboard new team members.
• Perform other duties as assigned and comply with policies and standards.

Education

Bachelor’s degree in a related field or equivalent experience

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.

Benefits

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. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

• 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

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.

Equal Opportunity & Diversity

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.

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.