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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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, Full time, Part time, Work at office, Remote work, Flexible hours,
Similar Jobs
Dress A Med
...you are still eligible to apply. --- Dress A Med ( LLC., a leading global brand in medical apparel based in Los Angeles, is seeking PAID interns. The Dress A Med Studio internship is a significant opportunity to learn while providing assistance to the Creative...
Crespo Services
If you are a people person, experienced Dental Assistant, presenting treatment plans, etc., and would like a full-time job in a busy dental office, please email your resume. At least one year of stable experience as a certified dental assistant. Must have Eaglesoft or...
Select Staffing
DescriptionNOW HIRING for Dispatchers in Gilroy CA,Job Summary: Responsible for coordinating the overall scheduling and dispatching of delivery operations by communicating with truck drivers through computers, phones or two-way radios. Assign drivers to trucks and make...
Philips
JOB DESCRIPTION Job Title Sales, District Manager - Oral Healthcare (West Zone) Job Description District Sales Manager... ...about our culture. Philips Transparency Details Total Target Earnings is composed of base salary + target incentive. At 95%...
Wodek Systems, Inc.
Class A Hazmat Truck Driver JobDAY/NIGHT Fuel Driver WEEKEND/ MOUNTAIN DIFFERENTIAL!!!!!! (denver metro area)1 craigslist - Map data OpenStreetMapcompensation: Paid Weeklyemployment type: full-timeFUEL TANKER DRIVER ,HOME NIGHTLY AND SLEEPER TRUCKS EARN...