Grievance and Appeals Coordinator I

Centene
Arizona
Workplace: RemoteFull timeUSD 19.43 - 32.98 hourlyFunction: Executive & General ManagementExperience: 2+ yearsEducation: high_schoolSkills: ["Analytical thinking","Communication","Attention to detail","Documentation management","Data entry"]

Analyze and resolve verbal and written claims and authorization appeals from providers, and pursue resolution of formal member grievances. Gather, review, and report member/provider complaints, prepare response letters, and maintain appeal and grievance files. Coordinate grievance and appeals activities as needed, support pay-for-performance programs and HEDIS-related tasks, and handle high volumes of documents including copying, faxing, and scanning. Must live in Arizona and work remotely.

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FursaFursa
Centene
Centene
1 day ago

Grievance and Appeals Coordinator I

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Last checked: 9 hours agoStatus: Live

Job Summary

Analyze and resolve verbal and written claims and authorization appeals from providers, and pursue resolution of formal member grievances. Gather, review, and report member/provider complaints, prepare response letters, and maintain appeal and grievance files. Coordinate grievance and appeals activities as needed, support pay-for-performance programs and HEDIS-related tasks, and handle high volumes of documents including copying, faxing, and scanning. Must live in Arizona and work remotely.
Location: Arizona
Workplace: Remote
Employment Type: Full time
Job Function: Executive & General Management
Seniority: Mid level

Key Responsibilities

  • •Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.
  • •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 and HEDIS production activities, including data entry, provider office calls, claims research, and document handling (copying, faxing, scanning).

Pay and Benefits

Salary: USD 19.43 - 32.98 hourly
Perks:Health Insurance401kPaid LeaveRemote Work

Key Requirements

  • •High school diploma or equivalent; associate’s degree preferred.
  • •2+ years of grievance or appeals, claims, related managed care experience, or relevant experience.
  • •Ability to analyze and resolve verbal and written claims and authorization appeals and member grievances.
  • •Experience gathering, analyzing, and reporting member and provider complaints, grievances, and appeals.
  • •Ability to manage large volumes of documents (copying, faxing, and scanning) and maintain accurate files.
Experience:2+ yearsManaged care
Education:High School
Skills:Analytical thinkingCommunicationAttention to detailDocumentation managementData entry

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn