Manager, Grievance & Appeals

Job not on LinkedIn

🕒 4 days ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Ensure appropriate processing of member grievance appeals, provider appeals, or requests for a State Fair Hearing • Serve as the point of contact with the State • Manage the day-to-day responsibilities of Grievance & Appeals Coordinators • Ensure grievances and appeals are processed within required time frames and contractual legal requirements • Monitor appeals and grievances and provide senior management with monthly trend reporting • Ensure member and provider grievances are processed and investigated according to contract requirements • Work with state, local, and federal governments, local communities, and the public on grievance and appeals matters • Integrate federal and state law changes into the company's regulatory system • Recommend solutions, ensure problems are corrected, and advise departments of corrective measures to prevent recurrence • Provide training and direction to agencies developing compliant procedures • Review and process incoming incident/accident reports

🎯 Requirements

• Bachelor's degree in a related field or equivalent experience • 3+ years of experience in healthcare/law, grievances and appeals • Previous experience as a lead in a functional area, managing cross-functional teams on large-scale projects, or supervisory experience • Supervisory experience may include hiring, training, assigning work, and managing staff performance

🏖️ Benefits

• Competitive pay • Health insurance • 401K plans • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules