Grievance and Appeals Coordinator II

5 days ago

Mesa, United States Arizona Complete Health Full time

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:

Analyze and resolve verbal and written claims and authorization grievance/appeals from providers and members. Resolve all State inquires related to complaints, grievances and appeals.

Review and process member and provider grievances and appeals within federal, state and organizational regulations and policies and procedures
Review claim grievance for reconsideration and either approve/deny based on determination level or prepare for medical review presentation. Prepare cases for medical review as necessary
Review and determine if claim grievance includes a potential quality or access issue
Collaborate with subject matter experts within the organization to obtain benefit and/or clinical opinions/interpretations of complex cases
Serve as liaison between member, provider 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

Education/Experience: Bachelors degree in related field or equivalent experience. 2+ years of claims, contracting, or related experience in a managed care environment.

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.


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.

Required Preferred Job Industries
  • Other

  • Manager II Grievance/Appeals

    2 weeks ago

    Costa Mesa, United States Elevance Health Full time

    Manager II Grievance/Appeals Claims Support *Location: CA Residential Requirement This position will work a hybrid model (remote and office). Ideal candidates will live in the state of California within 50 miles of one of our PulsePoint locations. The Manager II Grievance/Appeals is responsible for management oversight of grievances and appeals departmental...

  • Manager II Grievance/Appeals

    1 month ago

    Costa Mesa, United States Elevance Health Full time

    Description Manager II Grievance/Appeals - Claims Support Location: *CA Residential Requirement This position will work a hybrid model (remote and office). Ideal candidates will live in the state of California within 50 miles of one of our PulsePoint locations. The Manager II Grievance/Appeals is responsible for management oversight of grievances and...

  • Manager II Grievance/Appeals

    4 weeks ago

    Costa Mesa, United States Elevance Health Full time

    Description Manager II Grievance/Appeals - Claims Support Location: *CA Residential Requirement This position will work a hybrid model (remote and office). Ideal candidates will live in the state of California within 50 miles of one of our PulsePoint locations. The Manager II Grievance/Appeals is responsible for management oversight of grievances and...

  • Nurse Appeals-CA

    1 month ago

    Costa Mesa, United States Elevance Health Full time

    Nurse Appeals- California candidates only Location: This is a virtual position and prefer candidates reside within 50 miles of an Elevance Health PulsePoint location. Schedule: Monday - Friday 8:00 am to 4:30 pm PST Saturdays and Holidays required How you will make an impact: Responsible for investigating and processing and medical necessity appeals...

  • Nurse Appeals-CA

    4 weeks ago

    Costa Mesa, United States Elevance Health Full time

    Nurse Appeals- California candidates only Location: This is a virtual position and prefer candidates reside within 50 miles of an Elevance Health PulsePoint location. Schedule: Monday - Friday 8:00 am to 4:30 pm PST Saturdays and Holidays required How you will make an impact: Responsible for investigating and processing and medical necessity appeals...

  • ATSU - Research Project Coordinator II

    1 month ago

    Mesa, United States A.T. Still University Full time

    **Description** The Research Project Coordinator II is responsible for the successful planning and implementation for multiple ATSUs clinical and academic Research Support projects. Research Support projects and associated phases must be planned, monitored, and controlled, whereby they are delivered on time and following the respective research protocols....

  • ATSU - Research Project Coordinator II

    1 month ago

    Mesa, United States ATSU Full time

    The Research Project Coordinator II is responsible for the successful planning and implementation for multiple ATSUs clinical and academic Research Support projects. Research Support projects and associated phases must be planned, monitored, and controlled, whereby they are delivered on time and following the respective research protocols. The Research...

  • ATSU - Research Project Coordinator II

    4 weeks ago

    Mesa, United States atsu Full time

    The Research Project Coordinator II is responsible for the successful planning and implementation for multiple ATSUs clinical and academic Research Support projects. Research Support projects and associated phases must be planned, monitored, and controlled, whereby they are delivered on time and following the respective research protocols. The Research...

  • ATSU - Research Project Coordinator II

    1 month ago

    Mesa, United States ATSU Full time

    The Research Project Coordinator II is responsible for the successful planning and implementation for multiple ATSUs clinical and academic Research Support projects. Research Support projects and associated phases must be planned, monitored, and controlled, whereby they are delivered on time and following the respective research protocols. The Research...

  • ATSU - Research Project Coordinator II

    2 months ago

    Mesa, United States A. T. Still University Full time

    The Research Project Coordinator II is responsible for the successful planning and implementation for multiple ATS - Us clinical and academic Research Support projects. Research Support projects and associated phases must be planned, monitored, and c Project Coordinator, Research, Coordinator, Project, Communications, Education, Business Services

  • ATSU - Research Project Coordinator II

    4 weeks ago

    Mesa, United States A.T. Still University Full time

    **Description** The Research Project Coordinator II is responsible for the successful planning and implementation for multiple ATSUs clinical and academic Research Support projects. Research Support projects and associated phases must be planned, monitored, and controlled, whereby they are delivered on time and following the respective research protocols....

  • Collector Ii

    2 months ago

    Costa Mesa, United States BAHAMA Consulting Corporation Full time

    **TITLE**: Collector II **LOCATION**:Costa Mesa, CA **SCHEDULE**: Days 100% Onsite **PAY**: $20.00 - $28.00/ hour - This is the pay range that BAHAMA Consulting reasonably expects to pay someone for this position._ **FLSA STATUS**:Non-Exempt **SUMMARY**: The Collector serves as the account representative for Hoag in working with insurance companies,...

  • Maintenance - Level II

    1 month ago

    Mesa, United States MHC Equity Lifestyle Properties Full time

    With a culture of recognition and reputation for excellence, ELS is the ideal organization in which to develop a long and successful career! ELS is hiring for the position of Maintenance - Level II in Mesa, Arizona. What you'll do: As a Maintenance Worker you perform various maintenance duties requiring technical labor skills, including HVAC repairs and...

  • Maintenance - Level II

    3 weeks ago

    Mesa, United States MHC Equity Lifestyle Properties Full time

    With a culture of recognition and reputation for excellence, ELS is the ideal organization in which to develop a long and successful career! ELS is hiring for the position of Maintenance - Level II in Mesa, Arizona. What you'll do: As a Maintenance Worker you perform various maintenance duties requiring technical labor skills, including HVAC repairs and...

  • Program Assistant-Hospitality

    1 week ago

    Mesa, United States Southern Illinois University Full time

    Description The Program Assistant provides support to the Program Coordinator of Hospitality Services, Clients, and Touch of Nature Staff and works as part of a team to ensure the optimal client experience while maintaining high standards.  Examples of Duties - Handles incoming emails, phone calls, messages, and directs them accordingly....

  • Medical Claims Examiner Ii

    1 week ago

    Costa Mesa, United States Procare MSO, Inc. Full time

    **Position Summary: The** MSO Claims Examiner II processes routine and non-routine claims using established claim standards, and departmental policies and procedures. Accurately evaluates and adjudicates exception claims in a timely manner and according to set standards. Accurately evaluate and adjudicate professional, facilities, and ancillary claims as...

  • Dental Scheduling Coordinator

    1 month ago

    La Mesa, United States Smiles of La Mesa Full time

    Job DescriptionJob DescriptionThe Dental Scheduling Coordinator’s main job responsibility is to clearly explain treatment options and related costs.The Scheduling Coordinator is a liaison between the doctor and the patient and assists in the gathering of information in the new patient experience, as well as coordinating a treatment plan with the doctor and...

  • Dental Scheduling Coordinator

    4 weeks ago

    La Mesa, United States Smiles of La Mesa Full time

    Job DescriptionJob DescriptionThe Dental Scheduling Coordinator’s main job responsibility is to clearly explain treatment options and related costs.The Scheduling Coordinator is a liaison between the doctor and the patient and assists in the gathering of information in the new patient experience, as well as coordinating a treatment plan with the doctor and...

  • Case Manager Ii

    2 weeks ago

    Mesa, United States Encompass Health Full time

    Case Manager II **Case Manager Career Opportunity** **Recognized for your abilities as a Case Manager** Are you ready for a Case Management role that brings your career closer to home and heart? Join Encompass Health, where being a Case Manager goes beyond just a job; it positions you as a vital link between exceptional care and the transformative impact on...

  • Case Manager Ii

    3 days ago

    Mesa, United States Encompass Health Full time

    Case Manager II **Case Manager Career Opportunity** **Recognized for your abilities as a Case Manager** Are you ready for a Case Management role that brings your career closer to home and heart? Join Encompass Health, where being a Case Manager goes beyond just a job; it positions you as a vital link between exceptional care and the transformative impact on...