Job Description
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
**Location: Position will be in the office at our Tempe, AZ location. (** 1850 W. Rio Salado Pkwy, Ste 201 )
**Position Purpose:** 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 the pay-for-performance programs, including data entry, tracking, organizing, and researching information
+ Assist with HEDIS production functions including data entry, calls to provider's offices, and claims research.
+ Manage large volumes of documents including copying, faxing and scanning incoming mail
**Education/Experience:** High school diploma or equivalent. Associate's degree preferred. 2+ years grievance or appeals, claims or related managed care experience. Strong oral, written, and problem solving skills.
**Location: Position will be in the office at our Tempe, AZ location. (** 1850 W. Rio Salado Pkwy, Ste 201 )
Pay Range: $19.04 - $32.35 per hour
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Job Tags
Hourly pay, Holiday work, Remote job, Flexible hours,
Similar Jobs
Indra Air Traffic, Inc.
...We are looking for a Facility Manager to support our U.S. location and operations in Northern Europe (UK, Norway, Germany, Slovakia). The ideal candidate will oversee budget management, contractor supervision, supplier coordination, and facility planning while ensuring...
Carle Health
...position will be a part of the City of Peoria Social Services Unit (SSU). SSU personnel are... ...to the immediate attention of hospital administrative staff. Takes appropriate action on... ...in E-Verify and may provide the Social Security Administration and, if necessary, the...
Intellibee Inc
Agile Project Manager/Scrum Master,Atlanta, GA,United States Agile Project Manager/Scrum Master Project Manager/Scrum Master is responsible... ...with the Software Development Life Cycle (SDLC)~ Certified Scrum Master (CSM), Professional Scrum Master (PSM), or equivalent...
Allied Universal
...plans, employee assistance programs, company discounts, perks, and more for most full-time positions!As a **Security Professional - Government Patrols** in **San Jose, CA** , you will serve and safeguard clients in a range of industries such as Government and more .As a...
Nidec Motor Corporation
...best technologies and products; we will continue our part in creating a better society.Job SummaryJob DescriptionThe Director of Government Relations will interact with local, state, and federal legislative bodies and government agencies to represent and protect the...