Centene Corporation Grievance & Appeals Assistant in Linthicum Heights, Maryland

HourlyPosition Purpose: The Grievance and Appeals Assistant is responsible for ensuring proper intake and processing through resolution of member and provider grievances and appeals and regulatory body inquiries.

  • Maintain comprehensive knowledge of all products.

  • Receives appeal and grievance requests via the 800 appeals phone line, dedicated fax, I-MAX systems and by mail.

  • In accordance with both company policy and governmental regulations, triage appeal requests to determine appropriate area for resolution.

  • Identifies and initiates appropriate appeals into the expedited appeals process.

  • Responsible for initial data entry function of appeals activity into database and I-MAX.

  • Completes data entry functions, if necessary.

  • Upon completion of appeal, facilitates implementation of resolution.

  • Scans completed case files.

  • Assists departmental management in tracking and trending appeals and grievances.

  • Acts as liaison with other departments regarding appeals and grievances.

  • Assists with training new staff.

  • Actively participates in meetings.

  • Assists with special projects and performs other duties as necessary.

Education/Experience: One year experience in HMO/insurance setting required

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.

TITLE: Grievance & Appeals Assistant

LOCATION: Linthicum Heights, Maryland

REQNUMBER: 1099014

COMPANY: Health Insurance Operations

POSITION TYPE: Hourly

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.