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.
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
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
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience:
High school diploma or equivalent. Associate’s degree preferred. 2+ years grievance or appeals, claims, related managed care experience, or relevant experience.
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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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
