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Complaints Coordinator

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WorkatHome-JobBoard

17d ago

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

AI generated summary

  • You need a high school diploma, 3+ years in claims or customer service, and preferably a degree in healthcare. Provider relations and advanced knowledge in insurance or compliance are pluses.
  • You will handle and investigate complaints, maintain logs, ensure compliance with regulations, and coordinate documentation for responses to Members, Providers, and Regulatory agencies.

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

  • 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

FAQs

Do we support remote work?

Yes, this position offers the flexibility to work remotely from home anywhere in the United States.

What is the educational requirement for the Complaints Coordinator position?

A high school diploma or equivalent is required, while a Bachelor's degree in a healthcare-related field is preferred.

How many years of experience are needed for this role?

The position requires 3 or more years of claims, complaints, or customer service experience.

Is provider relations experience necessary?

Provider relations experience in a managed care or insurance environment is preferred but not mandatory.

What type of compliance knowledge is beneficial for this role?

An advanced knowledge of a technical or specialized field such as insurance, public health policy, complaints and appeals, compliance, or government affairs is preferred.

What are the working hours for the Complaints Coordinator position?

The role offers flexibility in work schedules that can be remote, hybrid, field, or office-based.

What is the pay range for this position?

The pay range for the Complaints Coordinator position is $22.36 to $38.07 per hour.

Does Centene offer benefits to its employees?

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

Is there a commitment to diversity at Centene?

Yes, Centene is committed to diversity and values the various ways in which individuals are different.

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