Lead Grievance & Appeals Coordinator

Company: Centene Corporation
Location: Corona
Posted on: May 15, 2022

Job Description:

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. -Position Purpose: Provide support and direction for the daily operations of the appeals function -

• Provide consultation for problem resolution for appeals staff and monitor team work output to ensure compliance with internal and NCQA standards
• Identify training, process improvement and resource needs to maximize team performance and recommend action plans to management
• Review denial and appeal letters as needed to ensure appropriate content and message
• Prepare for state/health plan audits, response to complaints and request for state fair hearing documentation
• Prepare monthly reports, logs, and other health plan or state contractual requirements
• Review and monitor team workload and output to ensure optimum efficiency and accuracy
• Serve as the point of contact for issues that arise from members, providers and internal team
• Train and educate new and existing team on processes, policies and procedures, and contract or market requirements -Our Comprehensive Benefits Package:
  • Flexible work solutions including remote options, hybrid work schedules and dress flexibility
  • Competitive pay
  • Paid Time Off including paid holidays
  • Health insurance coverage for you and dependents
  • 401(k) and stock purchase plans
  • Tuition reimbursement and best-in-class training and development
    Education/Experience: Bachelor's degree in related field or equivalent experience. 2+ years of grievance and appeals experience in a Healthcare or Managed Care setting.
    
    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.

Keywords: Centene Corporation, Corona , Lead Grievance & Appeals Coordinator, Other , Corona, California