Grievance & Appeals Coordinator I

Job not on LinkedIn

🔥 1 hour ago

🏄 California – Remote

🏄 California – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 10%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Just posted.
• Jobs at this company usually fill in 21 days.
• No salary listed.

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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 • May coordinate the Grievance and Appeals Committee • Support pay-for-performance programs through 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 • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• High school diploma or equivalent • 2+ years grievance or appeals, claims, related managed care experience, or relevant experience • Candidates must reside in California • Background in healthcare, appeals, and/or behavioral health preferred • Associate’s degree preferred • Overtime and weekend work may be required • Compliance with all policies and standards

🏖️ Benefits

• competitive pay • health insurance • 401K • 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

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