Grievance & Appeals Coordinator I

Centene Corporation•Remote-CA, CA

2d•$19 - $33•Hybrid

About The Position

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

Requirements

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
Candidates must reside near Woodland Hills, CA.
High school diploma or equivalent.
2+ years grievance or appeals, claims, related managed care experience, or relevant experience.

Nice To Haves

Associate’s degree preferred.

Responsibilities

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