Grievance & Appeals Coordinator II
Company: Centene Corporation
Location: Jefferson City
Posted on: November 22, 2022
You could be the one who changes everything for our 26 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
Position Purpose: Analyze and resolve verbal and written claims and
authorization grievance/appeals from providers and members. Resolve
all State inquires related to complaints, grievances and
Review and process member and provider grievances and appeals
within federal, state and organizational regulations and policies
Review claim grievance for reconsideration and either approve/deny
based on determination level or prepare for medical review
presentation. Prepare cases for medical review as necessary
Review and determine if claim grievance includes a potential
quality or access issue
Collaborate with subject matter experts within the organization to
obtain benefit and/or clinical opinions/interpretations of complex
Serve as liaison between member, provider regulatory agencies and
internal staff. Correspond with key individuals regarding grievance
and appeal decisions.
Act as subject matter expert regarding grievances and appeals.
Lead Appeals and Grievance Committee
Education/Experience: Bachelor's degree in related field or
equivalent experience. 2+ years of claims, contracting, or related
experience in a managed care environment.
Our Comprehensive Benefits Package: Flexible work solutions
including remote options, hybrid work schedules and dress
flexibility, Competitive pay, Paid time off including holidays,
Health insurance coverage for you and your dependents, 401(k) and
stock purchase plans, Tuition reimbursement and best-in-class
training and development.
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.
**TITLE:** Grievance & Appeals Coordinator II
**LOCATION:** Various, Missouri
Keywords: Centene Corporation, Jefferson City , Grievance & Appeals Coordinator II, Other , Jefferson City, Missouri
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