Grievance & Appeals Specialist I

Clinical Professional

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.

• NOTE : This is a mostly remote role with minimal travel (up to 10%) to the office for occasional in-person meetings with providers. Preference will be given to applicants who reside in Pennsylvania (ideally near one of our offices in Mechanicsburg, Pittsburgh, Philadelphia, Erie, or Moosic).

Additional Details :

Position Purpose : Responsible for reviewing, investigating and tracking member grievances and appeals, and provider claims disputes. Responsible for coordinating as necessary with the G&A Administrator and outside counsel during state fair hearing proceedings. PA Health and Wellness only - responsible for validating, assigning, and completing document folders and records for member grievances and complaints.

Education / Experience : Bachelor's degree or equivalent in a related field. 2+ years of behavioral health or physical health experience. Experience processing grievances and appeals preferred. PA Health and Wellness only : 1-2 years of related experience required. No Licenses required.

Pay Range : $22.79 - $38.84 per hour

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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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.