Delaware First Health Hiring for Grievance & Appeals Coordinator I at Delaware Full Time

You could be the one who changes everything for our 26 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.

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

Education/Experience: 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.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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.