You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

　　Position Purpose: Supports the documentation and processing of appeals, disputes and reconsiderations to ensure they are in accordance with state and National Committee for Quality Assurance (NCQA) requirements. Support the team to ensure appeals, disputes and reconsiderations are reviewed and processed timely.

　　Performs data entry to support the tracking, logging, and processing of appeals, disputes and reconsiderations in accordance with established regulatory and accreditation guidelines and procedures

　　Prepares correspondence for appeals, disputes and reconsiderations and maintains documentation files

　　Reviews and investigates appeals, disputes and reconsiderations requests to determine applicable follow up

　　Conducts research needed to evaluate, process, and respond to appeals, disputes and reconsiderations to ensure a timely decision

　　Prepares case files including supporting documentation and determinations needed to review, process, and report the appeals, disputes and reconsiderations

　　Gathers appeals, disputes and reconsiderations data to track and report on trends and final outcomes to team including conducting outreach for an update on statuses, determinations, and explanations

　　Performs other duties as assigned

　　Complies with all policies and standards

　　Education/Experience: Requires a High School diploma or GED

　　Requires 1 – 2 years of related experience.

　　Knowledge of appeals, disputes and reconsiderations process preferred.Pay Range: $19.24 - $32.69 per hour

　　Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

　　Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.