Lead Grievance Appeals Coordinator

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Lead Grievance & Appeals Coordinator

Position Purpose: Provide support and direction for the daily operations of the appeals function

- Provide consultation for problem resolution for appeals staff and monitor team work output to ensure compliance with internal and NCQA standards

- Identify training, process improvement and resource needs to maximize team performance and recommend action plans to management

- Review denial and appeal letters as needed to ensure appropriate content and message

- Prepare for state/health plan audits, response to complaints and request for state fair hearing documentation

- Prepare monthly reports, logs, and other health plan or state contractual requirements

- Review and monitor team workload and output to ensure optimum efficiency and accuracy

- Serve as the point of contact for issues that arise from members, providers and internal team

- Train and educate new and existing team on processes, policies and procedures, and contract or market requirements

Education/Experience: Bachelors degree in related field or equivalent experience. 2+ years of grievance and appeals experience in a Healthcare or Managed Care setting.

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.

Medical Management



  • 1
  • Negotiable
  • None
  • None
  • Re-115569
  • Permanent
  • 0

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