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Complaints Coordinator

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WorkatHome-JobBoard

16d ago

  • Job
    Full-time
    Mid Level
  • Government & Politics
    Healthcare
  • Hialeah
    Remote

AI generated summary

  • You need a high school diploma, 3+ years in claims or customer service, and provider relations experience preferred; a bachelor's in healthcare is a plus. Advanced knowledge in relevant fields is ideal.
  • You will manage complaints and appeals, ensure policy compliance, maintain logs, audit processes, and coordinate documentation with internal and external stakeholders.

Requirements

  • 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.

Responsibilities

  • 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

FAQs

What is the role of a Complaints Coordinator at Centene?

The Complaints Coordinator is responsible for receiving, investigating, and responding to member and provider complaints, including those received through state or federal regulatory agencies, while ensuring compliance with contractual and regulatory requirements.

What qualifications are required for the Complaints Coordinator position?

A high school diploma or equivalent is required, with a preference for a bachelor's degree in a healthcare-related field, along with 3+ years of claims, complaints, or customer service experience.

Is previous provider relations experience necessary for this role?

While not mandatory, provider relations experience in a managed care or insurance environment is preferred for the Complaints Coordinator position.

What kind of benefits does Centene offer?

Centene offers a comprehensive benefits package, including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work schedules.

What is the pay range for the Complaints Coordinator position?

The pay range for this role is between $22.36 and $38.07 per hour, adjusted based on individual skills, experience, education, and other job-related factors.

Does Centene have a commitment to diversity and equal opportunity?

Yes, Centene is an equal opportunity employer that values diversity and considers all qualified applicants without regard to various protected characteristics.

Can individuals with arrest or conviction records apply for this position?

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

How is the Complaints Coordinator involved with compliance and regulations?

The Complaints Coordinator assists in ensuring compliance with contract deliverables, as well as state and federal regulations, by maintaining logs and documentation related to complaints and complaint-appeals.

What is the work environment for this position?

The Complaints Coordinator position allows for flexibility in work arrangements, with the option to work remotely from home anywhere in the United States.

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