Grievance & Appeals Coordinator II

Centene Corporation

. Analyze and resolve verbal and written claims and authorization grievances/appeals from providers and members .

Posted 11/10/2026full-timeRemote • Florida • United StatesJuniorMid-Level💰 $23 - $40 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in analyzing and resolving grievances and appeals within managed care, ensuring compliance with federal, state, and organizational regulations. Strong communication and collaboration skills are essential for liaising with members, providers, and regulatory agencies.

Highest-signal resume keywords

Claims Grievance ResolutionManaged Care ExperienceRegulatory ComplianceWritten And Oral Communication SkillsCollaboration With Subject Matter Experts

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Grievance And Appeal ProcessingClaims ReviewMedical Review PreparationQuality And Access Issue DeterminationInvestigation And Resolution Of Complaints

Soft Skills

Strong Communication SkillsInterpersonal SkillsProblem-Solving Skills

Industry Keywords

Managed CareProvider RelationsMember ServicesRegulatory AgenciesAppeals And Grievances

About the role

Key responsibilities & impact

Analyze and resolve verbal and written claims and authorization grievances/appeals from providers and members
Resolve state inquiries related to complaints, grievances and appeals
Review and process member and provider grievances and appeals within applicable regulations, policies and procedures
Review claim grievances for reconsideration and approve/deny based on determination level or prepare for medical review presentation
Prepare cases for medical review as necessary
Review and determine whether claim grievances include potential quality or access issues
Collaborate with subject matter experts to obtain benefit and/or clinical opinions/interpretations of complex cases
Serve as liaison between members, providers, regulatory agencies and internal staff
Correspond with key individuals regarding grievance and appeal decisions
Act as subject matter expert regarding grievances and appeals
Lead Appeals and Grievance Committee
Perform other duties as assigned
Comply with all policies and standards

Requirements

What you’ll need

Bachelor’s degree in related field or equivalent experience
2+ years of claims, contracting, or related experience in a managed care environment
Experience investigating and resolving expressions of dissatisfaction from members and providers
Strong written and oral communication skills
Ability to review and process member and provider grievances and appeals within federal, state and organizational regulations, policies and procedures
Ability to review claims grievances for reconsideration and approve/deny based on determination level or prepare for medical review
Ability to determine whether claim grievances include potential quality or access issues
Ability to collaborate with subject matter experts to obtain benefit and/or clinical opinions/interpretations of complex cases

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
Competitive pay
Additional forms of incentives may be included in total compensation