Appeals Specialist

Centene Corporation

. Support documentation and processing of appeals, disputes and reconsiderations in accordance with state and NCQA requirements .

Posted 10/23/2026full-timeRemote • United StatesJunior💰 $20 - $35 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing appeals, disputes, and reconsiderations while ensuring compliance with state and NCQA requirements. Proficient in data entry, documentation management, and case tracking to support timely processing and reporting.

Highest-signal resume keywords

Appeals ProcessingDispute ResolutionData EntryCase ManagementResearch and Investigation

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data EntryCase TrackingDocumentation ManagementAppeals ProcessingDispute Processing

Soft Skills

Independent ManagementTime ManagementCommunication

Industry Keywords

NCQA RequirementsRegulated CaseworkGrievancesClaimsTimely Processing

About the role

Key responsibilities & impact

Support documentation and processing of appeals, disputes and reconsiderations in accordance with state and NCQA requirements
Ensure appeals, disputes and reconsiderations are reviewed and processed timely
Perform data entry for tracking, logging, and processing cases
Prepare correspondence and maintain documentation files
Review and investigate requests to determine applicable follow-up
Conduct research to evaluate, process, and respond to cases
Prepare case files with supporting documentation and determinations
Gather data to track and report trends and final outcomes
Conduct outreach for status updates, determinations, and explanations
Comply with all policies and standards
Perform other duties as assigned

Requirements

What you’ll need

High School diploma or GED
1–2 years of related experience
Knowledge of appeals, disputes and reconsiderations process preferred
Ability to work Eastern Time hours, 8:30 AM to 5:00 PM ET
Experience with appeals, grievances, claims, or other regulated casework is ideal
Ability to independently manage complex cases in a fast-paced, deadline-driven environment
No license or certification is required

Benefits

Comp & perks

Competitive pay
Health insurance
401K plan
Stock purchase plan
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation
Equal opportunity employer committed to diversity