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, youll 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 functionProvide consultation for problem resolution for appeals staff and monitor team work output to ensure compliance with internal and NCQA standardsIdentify training, process improvement and resource needs to maximize team performance and recommend action plans to managementReview denial and appeal letters as needed to ensure appropriate content and messagePrepare for state/health plan audits, response to complaints and request for state fair hearing documentationPrepare monthly reports, logs, and other health plan or state contractual requirementsReview and monitor team workload and output to ensure optimum efficiency and accuracyServe as the point of contact for issues that arise from members, providers and internal teamTrain and educate new and existing team on processes, policies and procedures, and contract or market requirementsEducation/Experience: Bachelors degree in related field or equivalent experience.
2+ years of grievance and appeals experience in a Healthcare or Managed Care setting.Our Comprehensive Benefits Package:Flexible work solutions including remote options, hybrid work schedules and dress flexibilityCompetitive payPaid Time Off including paid holidaysHealth insurance coverage for you and dependents401(k) and stock purchase plansTuition reimbursement and best-in-class training and developmentCentene 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.