PA Grievance & Appeals Specialist I

Centene Corporation; Pennsylvania; Hybrid; USD 32,000 - 55,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Flexible work schedules

Job summary

Centene Corporation in Pennsylvania seeks a Grievance and Appeals Specialist to review, investigate, and track member grievances and provider disputes. The role involves coordinating with G&A, outside counsel, and state proceedings to ensure timely, lawful resolutions.

Required are a bachelor’s degree and 2+ years in behavioral or physical health, with certification-eligibility within 6 months. Pay range follows a hourly schedule, with remote/hybrid/office work options available.

Qualifications

• Bachelor’s degree or equivalent in a related field.
• 2+ years of behavioral health or physical health experience.
• Experience processing grievances and appeals preferred.
• Certified by CLEAR or equivalent; certification must be obtained within 6 months of hire.
• 1-2 years of related experience required. No licenses required.

Responsibilities

• Screen all incoming grievances, appeals and provider claim disputes for compliance with ARS and ADHS/DBHS policies.
• Coordinate conferences with appropriate parties for appeal proceedings.
• Conduct grievance investigations via interviews and document review.
• Prepare investigative reports and Notices of Decision or Resolution.
• Audit files for quarterly, annual and ad-hoc audits.
• Manage daily entries into the DBHS Office of Grievance and Appeals database.

Skills

Grievance investigations

Interviews

Policy interpretation

Document handling

Education

Bachelor’s degree or equivalent

Tools

DBHS database

Job description

Centene Corporation in Pennsylvania seeks a Grievance and Appeals Specialist to review, investigate, and track member grievances and provider disputes. The role involves coordinating with G&A, outside counsel, and state proceedings to ensure timely, lawful resolutions.

Required are a bachelor’s degree and 2+ years in behavioral or physical health, with certification-eligibility within 6 months. Pay range follows a hourly schedule, with remote/hybrid/office work options available.