Lead Grievance & Appeals Coordinator
Company: Centene Corporation
Location: South Gate
Posted on: May 11, 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
developmentEducation/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, South Gate , Lead Grievance & Appeals Coordinator, Other , South Gate, California
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