Grievance & Appeals Coordinator I
Company: Centene
Location: Tulsa
Posted on: November 18, 2023
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Job Description:
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
workplace flexibility.
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 mail
Education/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, Tulsa , Grievance & Appeals Coordinator I, Other , Tulsa, Oklahoma
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