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Manager, Grievance & Appeals

Rancho Cordova, California Apply Now Job ID 1131659 Category Health Insurance Operations Organization Centene Corporation Schedule Full-time
Description:
Position Purpose: Ensure appropriate processing of member grievance appeals, provider appeals, or request for a State Fair Hearing. Perform duties as the point of contact with the State. Manage the day to day responsibilities of the Grievance & Appeals Coordinators.

  • Ensure that the Grievance and Appeals department processes all appeals and grievances in accordance with referred time frames and other contractual legal requirements
  • Monitor appeals and grievances and provide senior management with monthly reporting on trends
  • Ensure that all members and provider grievances are processed and investigated according to contract requirements
  • Work with various external constituencies, i.e., state, local and federal governments, local community and the public related to grievance and appeals
  • Integrate federal and state law changes into company’s regulatory system related to grievance and appeals
  • Recommend solutions and works with department and company staff to ensure problems are corrected and departments are advised of corrective measures to prevent recurrences
  • May provide training and direction to agencies in developing procedures to comply with grievance and appeals requirements
  • Review and process incoming incident/accident reports
  • Qualifications:

    Education/Experience: Bachelor’s degree in related field or equivalent experience. 3+ plus years of experience in healthcare/law, grievances and appeals. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.

    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.
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