Appeals Specialist II

Job not on LinkedIn

🔥 6 minutes ago

🐊 Florida, Illinois, +3 more states – Remote

🐊 Florida – Remote 🌽 Illinois – Remote 🚗 Michigan – Remote 🏰 Missouri – Remote 🎸 Tennessee – Remote

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Support documentation and processing of appeals, disputes and reconsiderations • Perform data entry for tracking, logging and processing cases • Prepare correspondence and maintain documentation files • Review and investigate requests to determine applicable follow-up • Conduct research to evaluate, process and respond to cases timely • Prepare case files with supporting documentation and determinations • Gather data to track and report trends and final outcomes • Conduct outreach for status updates, determinations and explanations • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future • High School diploma or GED required • 1–2 years of related experience required • Knowledge of appeals, disputes and reconsiderations process preferred • Experience with No Surprises Act (NSA) Open Negotiation Requests (ONRs), Independent Dispute Resolution (IDR), and/or state healthcare payment disputes preferred • Ability to perform data entry, documentation, research, case-file preparation, tracking and reporting related to appeals, disputes and reconsiderations • Must comply with all policies, standards, regulatory requirements and accreditation guidelines

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity