Logo of Huzzle

Home

Matches

Explore

Manage

Complaints Coordinator

image

WorkatHome-JobBoard

1mo ago

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

AI generated summary

  • You need a high school diploma, with a bachelor's in healthcare preferred, plus 3+ years in claims or customer service, and experience in managed care or insurance is a plus.
  • You will investigate and respond to complaints, ensure regulatory compliance, maintain logs, update policies, and coordinate information for complaint resolution.

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, you can work remotely from anywhere in the United States.

What is the main purpose of the Complaints Coordinator position?

The main purpose is to receive, investigate, and respond to Member and Provider complaints, including those from 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 Bachelor's degree in a healthcare-related field preferred. Additionally, 3+ years of claims, complaints, or customer service experience is necessary.

Is experience in a managed care or insurance environment preferred?

Yes, experience in provider relations within a managed care or insurance environment is preferred.

What types of complaints will the Complaints Coordinator be handling?

The Complaints Coordinator will handle Member, Provider, and Regulatory complaints and complaint-appeals.

What kind of benefits does Centene offer for this position?

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

Is this position eligible for additional incentives?

Yes, total compensation may include additional forms of incentives based on skills, experience, education, and other job-related factors.

Does Centene have a commitment to diversity and inclusion?

Yes, Centene is an equal opportunity employer committed to diversity and values the differences among individuals.

Will applicants with criminal records be considered for employment?

Yes, qualified applicants with arrest or conviction records will be considered in accordance with applicable laws and regulations.

image

WorkatHome-JobBoard

WorkAtHome-JobBoard is the leading job search site specializing in the best part-time jobs.

Marketing & Advertising
Industry
11-50
Employees

Mission & Purpose

WorkAtHome-JobBoard is the leading job search site specializing in the best remote, part-time, freelance, and flexible jobs available. Our job board offer different opportunities to anyone that want to earn extra money from home. Whether you are in the administrative field, retail or hospitality field, job offers contained on are continuously updated to maximize your chances of finding a part-time job that suits you.