Lead Grievance & Appeals Coordinator

Centene
Illinois
Workplace: RemoteFull timeUSD 23.23 - 39.61 hourlyFunction: Executive & General ManagementExperience: 2+ yearsEducation: bachelorsSkills: ["Coaching","Problem resolution","Compliance","Communication","Documentation"]

Lead the daily operations of the grievance and appeals function for an Illinois health plan Medicaid and YouthCare team. Maintain a reduced case load while monitoring team output for compliance with internal and NCQA standards, running daily huddles, and managing error processes. Provide problem resolution, coaching, and training, review denial and appeal letters, support state/health plan audits, and prepare monthly reports and fair hearing documentation as needed.

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FursaFursa
Centene
Centene
2 days ago

Lead Grievance & Appeals Coordinator

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Last checked: 2 hours agoStatus: Live

Job Summary

Lead the daily operations of the grievance and appeals function for an Illinois health plan Medicaid and YouthCare team. Maintain a reduced case load while monitoring team output for compliance with internal and NCQA standards, running daily huddles, and managing error processes. Provide problem resolution, coaching, and training, review denial and appeal letters, support state/health plan audits, and prepare monthly reports and fair hearing documentation as needed.
Location: Illinois
Workplace: Remote
Employment Type: Full time
Job Function: Executive & General Management
Seniority: Mid level

Key Responsibilities

  • •Provide support and direction for the daily operations of the appeals function
  • •Maintain a smaller case load while monitoring daily case completion, error management, and daily huddles
  • •Provide updates on status of assigned team members and contribute to job aids, Q&As, and process changes
  • •Review denial and appeal letters and ensure compliance with internal and NCQA standards
  • •Support state/health plan audits, complaints, state fair hearing documentation, and prepare monthly reports and logs

Pay and Benefits

Salary: USD 23.23 - 39.61 hourly
Equity and Bonus:Equity
Perks:Health Insurance401kPaid Leave

Key Requirements

  • •Bachelor’s degree in a related field or equivalent experience
  • •2+ years of grievance and appeals experience in a healthcare or managed care setting
  • •Provide problem resolution for appeals staff and monitor team output for compliance
  • •Review denial and appeal letters to ensure appropriate content and messaging
  • •Prepare documentation for state/health plan audits, complaint responses, and state fair hearings
Experience:2+ yearsHealthcareManaged careGrievance and appeals
Education:Bachelor's
Skills:CoachingProblem resolutionComplianceCommunicationDocumentation

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn