Grievance & Appeals Specialist I

Arizona Complete Health; Tempe (AZ); On-site; USD 27,000 - 45,000; Full time

Job summary

Centene is hiring an in-office Grievances and Appeals Specialist in Tempe, AZ to analyze and resolve verbal and written claims and authorization appeals from providers and members. The role requires full-time availability and residence in Arizona.

You will gather and report complaints, prepare response letters, maintain files, and support committee coordination. The position offers competitive pay and benefits, with a focus on improving care access.

Qualifications

• High school diploma or equivalent.
• Associate's degree preferred.
• 2+ years grievance or appeals, claims, related managed care experience, or relevant experience.

Responsibilities

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

Skills

Grievances

Appeals

Data analysis

Communications

Education

High school diploma or equivalent

Associate's degree preferred

Job description

Centene is hiring an in-office Grievances and Appeals Specialist in Tempe, AZ to analyze and resolve verbal and written claims and authorization appeals from providers and members. The role requires full-time availability and residence in Arizona.

You will gather and report complaints, prepare response letters, maintain files, and support committee coordination. The position offers competitive pay and benefits, with a focus on improving care access.