Grievance & Appeals Coordinator I

Job not on LinkedIn

🔥 7 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $19 - $32 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 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

• Analyze and resolve verbal and written claims and authorization appeals from providers • 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 • Coordinate the Grievance and Appeals Committee as needed • Support pay-for-performance programs through data entry, tracking, organizing, and researching information • Assist with HEDIS production functions, including data entry, calls to provider offices, and claims research • Manage documents, including copying, faxing, and scanning incoming mail • Perform other duties as assigned

🎯 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, California • High school diploma or equivalent • 2+ years of grievance or appeals, claims, related managed care experience, or relevant experience • Ability to gather, analyze, and report member and provider complaints, grievances, and appeals • Associate’s degree preferred • Ability to manage large volumes of documents • Ability to comply with all policies and standards

🏖️ Benefits

• Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off • 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