Lead Grievance & Appeals Coordinator

Job not on LinkedIn

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $23 - $39 / hour

⏰ Full Time

🟠 Senior

👻 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

• Provide support and direction for daily operations of the appeals function • Consult on problem resolution for appeals staff • Monitor team work output for compliance with internal and NCQA standards • Maintain a smaller caseload as a lead • Provide updates on daily case completion, error management, and team status • Run daily huddles • Contribute to job aids, Q&As, and process changes • Coach staff • Support the state fair hearing process as needed • Identify training, process improvement, and resource needs • Recommend action plans to management • Review denial and appeal letters for appropriate content and messaging • Prepare for state and health plan audits • Respond to complaints and requests for state fair hearing documentation • Prepare monthly reports, logs, and other health plan or state contractual requirements • Review and monitor team workload and output for efficiency and accuracy • Serve as point of contact for member, provider, and internal team issues • Train and educate new and existing team members on processes, policies, procedures, contract, and market requirements • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Bachelor’s degree in related field or equivalent experience • 2+ years of grievance and appeals experience in a Healthcare or Managed Care setting • Experience with healthcare or managed care grievance and appeals processes • Ability to work Monday–Friday, 8AM–5PM Central Time Zone • Availability for overtime as needed during the week • Availability for approximately every other weekend for on-call duties

🏖️ Benefits

• Competitive pay • 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 • Additional forms of incentives may be included in total compensation