Grievance & Appeals Coordinator I

About the position

The Grievance & Appeals Coordinator I plays a crucial role in the Medical Management/Health Services team at Centene, focusing on analyzing and resolving claims and authorization appeals from providers, as well as addressing formal grievances from members. This position involves gathering, analyzing, and reporting on complaints, preparing response letters, and maintaining organized files on appeals and grievances. The role supports various programs and functions within the organization, contributing to the overall efficiency and effectiveness of the healthcare services provided to members.

Responsibilities
? Analyze and resolve verbal and written claims and authorization appeals from providers.
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? Pursue resolution of formal grievances from members.
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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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? Coordinate the Grievance and Appeals Committee as needed.
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? Support 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.
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? 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.

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