Appeals Specialist

🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $20 - $34 / hour

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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 in accordance with state and NCQA requirements • Ensure appeals, disputes and reconsiderations are reviewed and processed timely • 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 • 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 • Comply with all policies and standards • Perform other duties as assigned

🎯 Requirements

• High School diploma or GED • 1–2 years of related experience • Knowledge of appeals, disputes and reconsiderations process preferred • Ability to work Eastern Time hours, 8:30 AM to 5:00 PM ET • Experience with appeals, grievances, claims, or other regulated casework is ideal • Ability to independently manage complex cases in a fast-paced, deadline-driven environment • No license or certification is required

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plan • 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