Grievance & Appeals Coordinator I

Centene Corporation

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

Posted 11/12/2026full-timeRemote • California • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in analyzing and resolving grievances and appeals within the healthcare sector, with a strong focus on compliance and data management. Proficient in handling member and provider complaints while supporting performance programs and maintaining accurate documentation.

Highest-signal resume keywords

Grievance And Appeals ManagementClaims ResearchData Entry And TrackingHealthcare ComplianceManaged Care Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Grievance AnalysisAppeals ResolutionClaims ProcessingData ReportingDocument Management

Soft Skills

Communication SkillsOrganizational SkillsProblem-Solving Skills

Industry Keywords

HealthcareManaged CareBehavioral HealthHEDISCalifornia Residency

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 verbal and written 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’s 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

High school diploma or equivalent
2+ years grievance or appeals, claims, related managed care experience, or relevant experience
Candidates must reside in California
Background in healthcare, appeals, and/or behavioral health preferred
Associate’s degree preferred
Overtime and weekend work may be required
Compliance with all policies and standards

Benefits

Comp & perks

competitive pay
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