Complaints Coordinator

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.
 

*Applicants for the job have the flexibility to work remote from home anywhere in the United States.

Position Purpose: Receive, investigate, and respond to Member and Provider complaints including complaints received through State or Federal regulatory agencies. Assist with ensuring compliance with contractual requirements and federal and state government reporting and regulations.

• Assist with the development, update and maintenance of complaint and complaint-appeals policies and procedures including Member, Provider, and Regulatory complaint correspondence

• Review and audit complaints against the Complaints Process and Procedures

• Maintain Complaint and Complaint-Appeal Logs to include all contractual and regulatory-required information

• Receive, process, track and maintain all Member, Provider and Regulatory complaints and complaint-appeals

• Maintain compliance with contract deliverables, State Contract with the Health & Human Services Commission (HHSC) and all state and federal regulations

• Coordinate applicable internal and external customers to obtain the necessary documentation and information necessary to respond to a Complaint or Complaint-appeal

Education/Experience: High school Diploma or equivalent. Bachelor’s degree in healthcare related field preferred. 3+ years of claims, complaints or customer service experience. Provider relations experience in a managed care or insurance environment preferred. Advanced knowledge of a technical or specialized field such as insurance, public health policy, complaints and appeals, compliance or government affairs preferred.

Pay Range: $22.36 - $38.07 per hour

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act