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Grievance & Appeals Coordinator II

Corporate
Various, MO Full Time
POSTED ON 4/27/2023 CLOSED ON 5/31/2023

Job Posting for Grievance & Appeals Coordinator II at Corporate

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 workplace flexibility.

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 appeals.

• Review and process member and provider grievances and appeals within federal, state and organizational regulations and policies and procedures
• 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 cases
• 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.

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Salary.com Estimation for Grievance & Appeals Coordinator II in Various, MO
$67,282 to $88,543
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