Member Grievance & Appeals Liaison

You could be the one who changes everything for our 26 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: Serve as the day-to-day contact for assigned health plans, interacting with Members, Providers and Health Plan Leaders to facilitate problem resolution and promote high client satisfaction

• Manage resolution of activities in CRM, including HICS from CMS according to defined turnaround times
• Utilize multiple systems to investigate escalated inquiries on Members and follow the member experience from beginning to resolution
• Conduct member outreach based on a variety of trends such as frequent caller data and out of network claim denials
• Work cross functionally with internal departments regarding client needs and requests, work procedures, gaps in policy, and other elements of supporting assigned clients and conduct member, provider and health plan telephonic education as needed
• Ability to travel (10-25%)
• Ensure compliance with State and Federal laws, following State and Federal guidelines as well as the procedures for the plans and the Corporation
• Collaborate with internal teams and external partners to resolve complaints and document issue and resolution in CRM
• Document appropriate client specific information in CRM
• Recommend workflows and policy as a result of Member feedback and escalation data analysis

Education/Experience: Bachelor’s degree in related field or equivalent experience. 2+ years of data management or data analytics experience. Supervisor/lead experience preferred.

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 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.