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. THIS POSITION IS FULLY REMOTE/WORK FROM HOME. TRAINING SCHEDULE IS MONDAY-FRIDAY 8AM - 5PM CENTRAL TIME ZONE. THE WORK SCHEDULE AFTER TRAINING IS MONDAY - FRIDAY EITHER 9AM - 5:30PM OR 9:30AM - 6PM CENTRAL TIME ZONE AND AS NEEDED SATURDAYS WITH WEEKDAY FLEX TIME OR OVERTIME PAY IF WORK MORE THAN 40 HOURS IN THE WEEK. 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 providers 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. Associates degree preferred. 2+ years grievance or appeals, claims, related managed care experience, or relevant experience. Pay Range: $19.43 - $32.98 per hour 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 Thanks for your interest in Centene and its subsidiary companies. Were so glad that youve decided to fill out an application and take the next step to find your purpose. Also, were here to help support you on your candidate journey. Should you need an accommodation, please email recruiting@centene.com. Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.
