Grievance & Appeals Specialist - In-Office Tempe

Centene Management Company LLC; Tempe (AZ); On-site; USD 27,000 - 45,000; Full time

Job summary

Centene Management Company LLC in Tempe, AZ is seeking a claims, grievances and appeals specialist to analyze and resolve verbal and written appeals from providers and respond to member grievances.

The role requires residency in Arizona, a high school diploma (associate's preferred) and 2+ years in grievance or appeals, claims within managed care. The pay range is $19.43 to $32.98 per hour, with benefits and flexible schedules.

Qualifications

• 2+ years grievance or appeals, claims, related managed care experience.
• High school diploma or equivalent; associate’s degree preferred.

Responsibilities

• Analyze and resolve verbal and written claims and authorization appeals from providers.
• Prepare response letters for member and provider complaints, grievances and appeals.
• Maintain files on individual appeals and grievances.
• Coordinate the Grievance and Appeals Committee as needed.
• Support pay-for-performance programs, including data entry and tracking.
• Assist with HEDIS production functions including data entry and calls to provider offices.
• Manage large volumes of documents including copying, faxing and scanning incoming mail.
• Ensure compliance with policies and standards.

Skills

Grievance handling

Appeals processing

Data entry

Documentation

Education

High school diploma or equivalent

Associate's degree preferred

Job description

Centene Management Company LLC in Tempe, AZ is seeking a claims, grievances and appeals specialist to analyze and resolve verbal and written appeals from providers and respond to member grievances.

The role requires residency in Arizona, a high school diploma (associate's preferred) and 2+ years in grievance or appeals, claims within managed care. The pay range is $19.43 to $32.98 per hour, with benefits and flexible schedules.