Grievance & Appeals Coordinator I

Centene; United States; Remote; USD 10,000 - 60,000; Full time

Job summary

An established industry player is seeking a clinical professional to join their Medical Management/Health Services team. In this role, you will have the opportunity to make a significant impact on the lives of 28 million members by analyzing and resolving claims and appeals. You will gather and report on member and provider complaints, prepare response letters, and support various programs that enhance service delivery. This position offers a comprehensive benefits package and promotes workplace flexibility, making it a great opportunity for those looking to balance their professional and personal lives while contributing to a meaningful mission.

Benefits

Health insurance

401K

Stock purchase plans

Tuition reimbursement

Paid time off

Flexible work schedules

Qualifications

• 2+ years experience in grievance or appeals, claims, or managed care.
• Strong oral, written, and problem-solving skills required.

Responsibilities

• Analyze and resolve claims and authorization appeals from providers.
• Prepare response letters for member and provider complaints.
• Maintain files on individual appeals and grievances.

Skills

Problem-solving skills

Oral communication

Written communication

Education

High school diploma or equivalent

Associate’s degree

Job description

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.

Location: Position will be in the office at our Tempe, AZ location. (1850 W. Rio Salado Pkwy, Ste 201)

Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.

• Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
• Prepare response letters for member and provider complaints, grievances and appeals
• Maintain files on individual appeals and grievances
• May coordinate the Grievance and Appeals Committee
• Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
• Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research
• Manage large volumes of documents including copying, faxing and scanning incoming mail

Education/Experience: High school diploma or equivalent. Associate’s degree preferred. 2+ years grievance or appeals, claims or related managed care experience. Strong oral, written, and problem-solving skills.

Pay Range: $19.04 - $32.35 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.