Supervisor, Grievance & Appeals

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🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $56.2k - $101k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 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

• Supervise the day-to-day operations of the Appeals and Grievance staff and functions • Ensure productivity and quality metrics are met • Support the team on escalated or complex issues • Monitor and distribute case load • Ensure appeals, grievances, and complaints are processed according to standards and corporate policies and procedures • Serve as a resource regarding escalated or complex issues, process and systems issues, and regulatory updates • Monitor and distribute the team’s case load and ensure adequate coverage • Monitor and evaluate performance standards and provide daily feedback and guidance on problem resolution • Identify and develop process-improvement opportunities and work with various departments to prevent recurrences • Train and onboard new team members • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Bachelor’s degree in a related field or equivalent experience • 2+ years of appeals and grievances processing experience in a healthcare or managed care setting preferred • Experience in healthcare law preferred • Must be able to work rotational weekends and holidays to meet turnaround time frames • Must work core business hours Monday–Friday, 8am–5pm • Experience supervising Appeals and Grievance staff and functions • Knowledge of appeals, grievances, complaints, healthcare or managed care processes, policies and procedures, and regulatory requirements

🏖️ Benefits

• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • a flexible approach to work with remote, hybrid, field or office work schedules • bonus eligible

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