Grievance & Appeals Coordinator I

🔥 12 hours ago

🏄 California – Remote

🏄 California – Remote

💵 $19 - $32 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

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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 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

• Candidates must reside in California • High school diploma or equivalent • 2+ years of grievance or appeals, claims, related managed care experience, or relevant experience • Previous experience in healthcare, customer service, and/or claims preferred • Associate’s degree preferred • Ability to analyze and resolve verbal and written claims and authorization appeals • Ability to gather, analyze, and report complaints, grievances, and appeals • Ability to prepare response letters • Ability to maintain files on individual appeals and grievances • Ability to manage large volumes of documents • Compliance with all policies and standards

🏖️ Benefits

• Competitive pay • 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 • Benefits may be subject to program eligibility

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