申诉主管

Position Purpose: Supervises the processing and review of appeals, disputes, and reconsiderations including escalation for the most complex issues in accordance with state and National Committee for Quality Assurance (NCQA) requirements. Supervises day-to-day activities and provides guidance to the team to ensure appeals are reviewed and processed timely.
Key Details: Our Shared services team is hiring a Remote Supervisor, Appeals to lead a team focused on delivering accurate, timely, and compliant outcomes. We are seeking an experienced people leader with a strong background in managed care, appeals, and claims who can develop talent, navigate complex challenges, and drive continuous improvement.

• Monitors and tracks appeals, disputes, and reconsiderations issues to ensure documentation, processing, and resolution is in accordance with established policies and procedures

• Provides expert knowledge and guidance based on experience to the appeals, disputes, and reconsiderations team for issue resolution and processing to ensure compliance with state and National Committee for Quality Assurance (NCQA) requirements

• Maintains knowledge of contract requirements, policies, procedures, and performance standards

• Ensures appeals, disputes, and reconsiderations team’s compliance with contract requirements, policies, procedures, and performance standards

• Works with team to identify opportunities for process and quality improvements

• Evaluates team performance and provides feedback regarding performance, goals, and career milestones

• Provides coaching and guidance to team to ensure timely resolution of appeals, disputes and reconsiderations

• Assists with onboarding, hiring, and training team members

• Leads and champions change within scope of responsibility

• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience: Requires a Bachelor's degree and 4+ years of related experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
This remote position requires availability to work Central Time Zone hours.
Pay Range: $63,600.00 - $114,600.00 per year

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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
Originally posted on Himalayas