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Grievance & Appeals Coordinator I
Centene - Springfield, IL
posted 2 months ago
About the position
The Grievance & 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 fully remote and involves a structured schedule with opportunities for voluntary overtime. The coordinator will be responsible for maintaining detailed records of grievances and appeals, preparing response letters, and supporting various operational functions within the Medical Management/Health Services team.
Responsibilities
- Analyze and resolve verbal and written claims and authorization appeals from providers.
- 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 including remote, hybrid, field or office work options.
