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Grievance & Appeals Coordinator I
$38,813 - $65,998/Yr
Centene
posted 2 months ago
Full-time - Entry Level
Remote
Ambulatory Health Care Services
About the position
The Grievance & Appeals Coordinator I 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 of complaints, contributing to the overall satisfaction of Centene's 28 million members.
Responsibilities
- Analyze and resolve verbal and written claims and authorization appeals from providers.
- 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.
Requirements
- 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.
Benefits
- Competitive pay
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible work schedules (remote, hybrid, field or office)
