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: The Supervisor of Appeals & Grievances is accountable for the recruitment, hiring, promotion, counseling, and daily supervision of Grievance and Appeals Specialists and administrative support as they receive, investigate and resolve member complaints, member grievances, and provider disputes.
This position is also responsible for the coordination of the resolution of grievance situations requiring competent and effective resolution in compliance with legal and regulatory requirements.
This position will also perform initial and ongoing training in necessary skills and knowledge base and will assist Manager of Grievance and Appeals to establish and maintain procedures for Unit to maximize both outcomes and operational efficiency.Provides daily supervision for Grievance and Appeals Unit, including coordination of backup staffing, cross-training and deployment.Performs recruiting, hiring, promotion, and performance evaluation tasks and counsels non-clinical Grievance and Appeals staff.Orients and trains new Grievance and Appeals Unit members.Continually trains Unit members concerning grievances, appeals, and provider disputes/appeals.Regularly audits work of G& A Specialists and reports results.Coordinates investigation and resolution of complex appeal and grievance issues.Provides approval decisions involving grievance and appeal determinations.Coordinates maintenance and updates of desktop procedures and manuals for Unit.Assists in the establishment of grievance operating procedures.Prepares reports as required and performs trend analyses.Participates in Health Plan audits as needed.Performs other related duties as required.Education/Experience: High School Diploma.
Bachelors Degree preferred.
5+ years of experience in Managed Care.
2+ supervisory experience preferred.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.