Grievance & Appeals Specialist I

Arizona Complete Health; Arizona; Presencial; USD 27.000 - 45.000; Jornada completa

Descripción de la vacante

Centene in Tempe, AZ is hiring for a full-time position focused on analyzing and resolving verbal and written claims, appeals, and grievances from providers and members. The role requires in-office presence in Tempe, with mailroom activities and related duties.

Responsibilities include preparing response letters, maintaining case files, supporting committee coordination, and assisting with HEDIS data entry and claims research.

Formación

• 2+ years grievance or appeals, claims, or related managed care experience.
• Experience analyzing and resolving verbal and written complaints is preferred.
• Knowledge of pay-for-performance programs and HEDIS data entry is a plus.

Responsabilidades

• 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 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.
• Performs other duties as assigned.
• Complies with all policies and standards.

Conocimientos

Grievance handling

Claims processing

Data entry

Communication

Educación

High School Diploma or equivalent

Associate's degree preferred

Herramientas

MS Office

EHR systems

Descripción del empleo

Centene in Tempe, AZ is hiring for a full-time position focused on analyzing and resolving verbal and written claims, appeals, and grievances from providers and members. The role requires in-office presence in Tempe, with mailroom activities and related duties.

Responsibilities include preparing response letters, maintaining case files, supporting committee coordination, and assisting with HEDIS data entry and claims research.