Grievance & Appeals Coordinator I
Company: Centene Corporation
Posted on: November 18, 2023
You could be the one who changes everything for our 28 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
Must live in OklahomaOklahoma Complete Health, a Centene company,
is committed to providing quality healthcare solutions to transform
the health of Oklahomans.
At Oklahoma Complete Health, we are community advocates and
change-makers in search of an inclusive culture grounded by our
commitment to work-life balance, competitive compensation, and
continuous career development. Join us and be a part of a
collaborative, growing network of innovative thinkers delivering
solutions at the local level.Position Purpose: Analyze and resolve
verbal and written claims and authorization appeals from providers
and pursue resolution of formal grievances from members.
- Gather, analyze and report verbal and written member and
provider complaints, grievances and appeals
- Prepare response letters for member and provider complaints,
grievances and appeals
- Maintain files on individual appeals and grievances
- May coordinate the Grievance and Appeals Committee
- Support the pay-for-performance programs, including data entry,
tracking, organizing, and researching information
- Assist with HEDIS production functions including data entry,
calls to provider's offices, and claims research.
- Manage large volumes of documents including copying, faxing and
scanning incoming mailEducation/Experience: High school diploma or
equivalent. Associate's degree preferred. 2+ years grievance or
appeals, claims or related managed care experience. Strong oral,
written, and problem solving skills.
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.
Keywords: Centene Corporation, Tulsa , Grievance & Appeals Coordinator I, Other , Tulsa, Oklahoma
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