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
- 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.
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.