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.
***This is a fully remote position. Candidates must be able and willing to work a Monday through Friday schedule from 8:00 AM to 5:00 PM Eastern Time. This role also includes participation in a holiday rotation, requiring work on up to two holidays per year, for up to four hours per holiday.***
Appeals experience is strongly preferred.
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
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience: High school diploma or equivalent. Associate’s degree preferred. 2+ years grievance or appeals, claims, related managed care experience, or relevant experience.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Centene Corporation Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Centene Corporation and has not been reviewed or approved by Centene Corporation.
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Leave & Time Off Breadth — Paid holidays, vacation, personal and sick time are provided alongside paid parental and caregiver leave, with adoption reimbursement also available. Feedback suggests time-off policies are broad enough to support major life events and everyday needs.
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Flexible Benefits — Flexible schedules, remote work options, relaxed dress codes, and an Employee Assistance Program are offered along with discounts on products and services. Feedback suggests this flexibility enhances work-life balance across varied roles and locations.
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Retirement Support — A 401(k) retirement plan with company match and an employee stock purchase plan support long‑term financial wellbeing. Feedback suggests these programs form a stable foundation within the total rewards package.
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What We Do
Centene provides healthcare solutions to individuals across the United States with more than 23 million members nationwide.
