What are the responsibilities and job description for the Grievance & Appeals Assistant position at Centene Management Company LLC?
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.
In-office position located at 21281 Burbank Blvd, Woodland Hills, CA 91367
Monday-Friday 9:30am-6pm PST; Holiday rotation.
Position Purpose: The Grievance and Appeals Assistant is responsible for ensuring proper intake and processing through resolution of member and provider grievances and appeals and regulatory body inquiries.
- Maintain comprehensive knowledge of all products.
- Receives appeal and grievance requests via the 800 appeals phone line, dedicated fax, I-MAX systems and by mail.
- In accordance with both company policy and governmental regulations, triage appeal requests to determine appropriate area for resolution.
- Identifies and initiates appropriate appeals into the expedited appeals process.
- Responsible for initial data entry function of appeals activity into database and I-MAX.
- Completes data entry functions, if necessary.
- Upon completion of appeal, facilitates implementation of resolution.
- Scans completed case files.
- Assists departmental management in tracking and trending appeals and grievances.
- Acts as liaison with other departments regarding appeals and grievances.
- Assists with training new staff.
- Actively participates in meetings.
- Assists with special projects and performs other duties as necessary.
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. Total compensation may also include additional forms of incentives.
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
Salary : $19 - $32
