Grievance and Appeals Coordinator I

About the position

The Grievance and Appeals Coordinator I at Centene Corporation plays a crucial role in analyzing and resolving claims and authorization appeals from providers, as well as addressing formal grievances from members. This position is essential for ensuring effective communication and resolution processes within the Medical Management/Health Services team, ultimately impacting the experience of 28 million members.

Responsibilities
? Analyze and resolve verbal and written claims and authorization appeals from providers.
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? Gather, analyze and report verbal and written member and provider complaints, grievances and appeals.
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? Prepare response letters for member and provider complaints, grievances and appeals.
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? Maintain files on individual appeals and grievances.
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? May coordinate the Grievance and Appeals Committee.
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? Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information.
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? Assist with HEDIS production functions including data entry, calls to provider's offices, and claims research.
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? Manage large volumes of documents including copying, faxing and scanning incoming mail.

Requirements
? High school diploma or equivalent; Associate's degree preferred.
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? 2+ years grievance or appeals, claims or related managed care experience.
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? Strong oral, written, and problem-solving skills.

Nice-to-haves

Benefits
? Competitive pay
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? Health insurance
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? 401K and stock purchase plans
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? Tuition reimbursement
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? Paid time off plus holidays
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? Flexible work schedules including remote, hybrid, field or office work options.

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