Offer summary

Qualifications:

High school diploma or equivalent; Associate’s degree preferred., 2+ years of experience in grievance or appeals, claims, or related managed care., Strong oral, written, and problem-solving skills are essential., Healthcare grievance and appeals experience is strongly preferred..

Key responsabilities:

Analyze and resolve verbal and written claims and authorization appeals from providers.

Gather, analyze, and report member and provider complaints, grievances, and appeals.

Prepare response letters for complaints, grievances, and appeals.

Manage large volumes of documents including copying, faxing, and scanning incoming mail.

Job description

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

***Remote position. Must reside in California***

2+ years grievance or appeals, claims or related managed care experience. Healthcare grievance and appeals experience strongly preferred.

Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and 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 the pay-for-performance programs, including 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

Education/Experience: High school diploma or equivalent. Associate’s degree preferred. 2+ years grievance or appeals, claims or related managed care experience. Strong oral, written, and problem solving skills.

Pay Range: $19.04 - $32.35 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Required profile