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Grievance & Appeals Coordinator I - Bonus Eligible - Remote Nationwide

Company: Nebraska Total Care
Location: Bellevue
Posted on: January 12, 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, youll have access to 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 providers offices, and claims research.
  • Manage large volumes of documents including copying, faxing and scanning incoming mailOur 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 development
      Education/Experience: High school diploma or equivalent. Associates degree preferred. 2+ years grievance or appeals, claims or related managed care experience. Strong oral, written, and problem solving skills.

      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: Nebraska Total Care, Bellevue , Grievance & Appeals Coordinator I - Bonus Eligible - Remote Nationwide, Other , Bellevue, Nebraska

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