Grievance Appeals Coordinator II

Other jobs >> General

Negotiable

Permanent

Description

Grievance & Appeals Coordinator II



Position Purpose: Analyze and resolve verbal and written claims and authorization grievance/appeals from providers and members. Resolve all State inquires related to complaints, grievances and appeals.



- Review and process member and provider grievances and appeals within federal, state and organizational regulations and policies and procedures



- Review claim grievance for reconsideration and either approve/deny based on determination level or prepare for medical review presentation. Prepare cases for medical review as necessary



- Review and determine if claim grievance includes a potential quality or access issue



- Collaborate with subject matter experts within the organization to obtain benefit and/or clinical opinions/interpretations of complex cases



- Serve as liaison between member, provider regulatory agencies and internal staff. Correspond with key individuals regarding grievance and appeal decisions.



- Act as subject matter expert regarding grievances and appeals.



- Lead Appeals and Grievance Committee



Education/Experience: Bachelors degree in related field or equivalent experience. 2+ years of claims, contracting, or related experience in a managed care environment. Grievance and Appeals experience highly preferred.



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



USA-California-Woodland Hills



Medicare



Full-time
  • 1
  • Negotiable
  • None
  • None
  • Re-132936
  • Permanent
  • 1

How to Apply: Please click here to create a free Pure-jobs.com account and post your resume. Only logged in job seekers can apply for a job.

Find us at:

Never provide bank account, credit card details or any other financial information, or make any form of payment, when applying for a job. If you are ever asked to do this by a recruiter on Pure Jobs please click the Report button or contact us with the advertiser's company name and the title of the job vacancy. You should not send any money to anyone. A genuine employer with a job offer would never ask you to do this.

Report this job
x

Report a job

If you're concerned about a job advert, let us know and our quality team will investigate.

Your name(*)
Invalid Input

Your email address(*)
Invalid Input

Please select you reason(*)

Additional information(*)
Invalid Input

Invalid Input

Get new jobs for this search by email.

Also get an email with jobs recommended just for me.

Create Alert



Subscribe to updates from our blog