Grievance & Appeals Coordinator I

Centene Corporation

. Analyze and resolve verbal and written claims and authorization appeals from providers .

Posted 9/17/2026full-timeRemote • California • United StatesJuniorMid-Level💰 $19 - $33 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in analyzing and resolving claims and grievances, with a strong focus on data management and compliance within managed care environments. Proficient in preparing documentation and supporting performance programs through effective organization and communication.

Highest-signal resume keywords

Grievance And Appeals ManagementClaims ResearchData Entry And TrackingDocument ManagementHEDIS Production Functions

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AnalysisGrievance ResolutionData ReportingDocument PreparationFile MaintenanceData EntryResearch SkillsOrganizational SkillsVerbal CommunicationWritten Communication

Certifications & Qualifications

High School DiplomaAssociate’s Degree Preferred

Industry Keywords

Managed CarePay-For-Performance ProgramsMember ComplaintsProvider ComplaintsFormal GrievancesAppeals ProcessHEDIS

About the role

Key responsibilities & impact

Analyze and resolve verbal and written claims and authorization appeals from providers
Pursue resolution of formal grievances from members
Gather, analyze, and report member and provider complaints, grievances, and appeals
Prepare response letters for member and provider complaints, grievances, and appeals
Maintain files on individual appeals and grievances
May coordinate the Grievance and Appeals Committee
Support pay-for-performance programs through data entry, tracking, organizing, and researching information
Assist with HEDIS production functions, including data entry, calls to provider offices, and claims research
Manage large volumes of documents, including copying, faxing, and scanning incoming mail
Perform other duties as assigned
Comply with all policies and standards

Requirements

What you’ll need

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
Must reside near Woodland Hills, California
High school diploma or equivalent
2+ years of grievance or appeals, claims, related managed care experience, or relevant experience
Associate’s degree preferred

Benefits

Comp & perks

Health insurance
401K
Stock purchase plans
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