Grievance & Appeals Coordinator I

Centene Management Company • Tempe, AZ

6d • Onsite

About The Position

The Grievance & Appeals Coordinator I analyzes and resolves verbal and written claims and authorization appeals from providers and pursues resolution of formal grievances from members. The role gathers, analyzes, and reports member and provider complaints, grievances, and appeals, prepares response letters, and maintains files on individual cases. It may also coordinate the Grievance and Appeals Committee.

The coordinator supports pay-for-performance programs through data entry, tracking, organizing, and research, and assists with HEDIS production, including data entry, calls to provider offices, and claims research. The position also manages large volumes of documents, including copying, faxing, and scanning incoming mail, and performs other assigned duties while complying with company policies and standards. Candidates must reside in Arizona and work full-time in the office at the Tempe, Arizona location.

Requirements

• High school diploma or equivalent.
• At least 2 years of grievance or appeals, claims, related managed care, or relevant experience.
• Must reside in Arizona.
• Must be able to work full-time in the office at the Tempe, Arizona location.

Nice To Haves

• Associate’s degree.
• Mailroom 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 pay-for-performance programs through data entry, tracking, organizing, 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.
• Perform other duties as assigned.
• Comply with all policies and standards.

Benefits

• Competitive pay
• Health insurance
• 401(k) and stock purchase plans
• Tuition reimbursement
• Paid time off and holidays
• Flexible approach to work schedules, including remote, hybrid, field, or office schedules

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED