Appeals Specialist

Centene Corporation • Remote-NY, NY

1d • $20 - $35 • Remote

About The Position

The Appeals Specialist supports the documentation and processing of appeals, disputes, and reconsiderations to ensure compliance with state and NCQA requirements. The role helps ensure these matters are reviewed and processed on time. This is a fully remote position open to candidates anywhere in the United States, with working hours of 8:30 AM to 5:00 PM Eastern Time. The position is suited to someone who can independently manage complex cases in a fast-paced, deadline-driven environment. No license or certification is required.

Requirements

• High school diploma or GED.
• One to two years of related experience.

Nice To Haves

• Knowledge of the appeals, disputes, and reconsiderations process.

Responsibilities

• Perform data entry to track, log, and process appeals, disputes, and reconsiderations according to regulatory and accreditation guidelines and procedures.
• Prepare correspondence and maintain documentation files for appeals, disputes, and reconsiderations.
• Review and investigate requests to determine appropriate follow-up.
• Conduct research to evaluate, process, and respond to cases in a timely manner.
• Prepare case files with supporting documentation and determinations for review, processing, and reporting.
• Gather case data to track and report trends and outcomes, including conducting outreach to obtain status updates, determinations, and explanations.
• Perform other duties as assigned.
• Comply with all policies and standards.

Benefits

• Competitive pay
• Health insurance
• 401(k) and stock purchase plans
• Tuition reimbursement
• Paid time off and holidays
• Flexible work approach with remote, hybrid, field, or office schedules
• Potential additional incentives, subject to applicable factors and eligibility

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED