Grievance & Appeals Specialist I

Centene Corp.; Tempe (AZ); Presencial; USD 27.000 - 45.000; Tempo integral

Resumo da vaga

Centene Corp. in Tempe, AZ is seeking a full-time Grievance and Appeals Analyst to analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.

The role requires being in-office at our Tempe location. Responsibilities include gathering and reporting complaints, preparing responses, maintaining files, coordinating committees, and supporting pay-for-performance and HEDIS processes.

Qualificações

• High school diploma or equivalent required; Associate's degree preferred.

Responsabilidades

• Gather, analyze and report 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 and researching information.
• Assist with HEDIS production functions including data entry, calls to provider 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.

Conhecimentos

Grievance/Appeals experience

Data entry

Formação

High school diploma or equivalent

Associate's degree preferred

Descrição da vaga

Centene Corp. in Tempe, AZ is seeking a full-time Grievance and Appeals Analyst to analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.

The role requires being in-office at our Tempe location. Responsibilities include gathering and reporting complaints, preparing responses, maintaining files, coordinating committees, and supporting pay-for-performance and HEDIS processes.