Manager, Grievance & Appeals

Centene
Pennsylvania
Workplace: RemoteFull timeUSD 70,100 - 126,200 annuallyFunction: Administration & Executive AssistanceExperience: 3+ yearsEducation: bachelorsSkills: ["Leadership","Cross-functional collaboration","Problem-solving","Compliance focus","Reporting"]

Manage member grievance and provider appeals, serving as the point of contact with the State and ensuring all cases are processed, investigated, and reported within required time frames. Lead day-to-day Grievance & Appeals Coordinators, monitor trends with monthly reporting, and integrate federal/state law changes into the department’s process. Work with state and federal agencies, recommend corrective solutions, and review incident/accident reports.

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FursaFursa
Centene
Centene
6 days ago

Manager, Grievance & Appeals

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Source: Company careers pageValidated by: Fursa AI
Last checked: 7 hours agoStatus: Live

Job Summary

Manage member grievance and provider appeals, serving as the point of contact with the State and ensuring all cases are processed, investigated, and reported within required time frames. Lead day-to-day Grievance & Appeals Coordinators, monitor trends with monthly reporting, and integrate federal/state law changes into the department’s process. Work with state and federal agencies, recommend corrective solutions, and review incident/accident reports.
Location: Pennsylvania
Workplace: Remote
Employment Type: Full time
Job Function: Administration & Executive Assistance
Seniority: Manager level

Key Responsibilities

  • •Ensure appropriate processing of member grievance appeals, provider appeals, and State Fair Hearing requests.
  • •Manage the day-to-day responsibilities of the Grievance & Appeals Coordinators.
  • •Ensure appeals and grievances are processed within referred time frames and contractual/legal requirements.
  • •Monitor trends and provide senior management with monthly reporting.
  • •Integrate federal and state law changes, recommend solutions, and review incoming incident/accident reports.

Pay and Benefits

Salary: USD 70,100 - 126,200 annually
Perks:Health Insurance401kPaid LeavePaid HolidaysRemote Work

Key Requirements

  • •Bachelor’s degree in a related field or equivalent experience.
  • •3+ years of experience in healthcare/law, grievances and appeals.
  • •Experience as a lead in a functional area, managing cross-functional teams on large-scale projects.
  • •Supervisory experience including hiring, training, assigning work, and managing performance of staff.
Experience:3+ yearsHealthcareLawGrievances and appeals
Education:Bachelor's
Skills:LeadershipCross-functional collaborationProblem-solvingCompliance focusReporting

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