Grievance & Appeals Coordinator I

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🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $19 - $32 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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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 member and provider complaints, grievances and appeals • Prepare response letters for 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, provider-office calls and claims research • Manage documents through 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 • Prefer applicants who reside in the state of Illinois • Monday–Friday availability during training, 8am–5pm Central Time • Monday–Friday availability after training, 8:30am–5pm Central Time with a 30-minute lunch • Associate’s degree preferred

🏖️ Benefits

• 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 • Overtime offered as needed