Grievance and Appeals Coordinator I (Centene Corporation)

About the Role

Grievance & Appeals Coordinator I

locations

Remote-MO

Remote-TN

Remote-OH

Remote-TX

Remote-FL

time type

Full time

job requisition id

1629237

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
***POSITION IS REMOTE***

Position Purpose:
Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.

• 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.
  Education/Experience:
  High school diploma or equivalent. Associate’s degree preferred. 2+ years grievance or appeals, claims, related managed care experience, or relevant experience.
  
  Pay Range: $19.43 - $32.98 per hour

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.