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Coordinator, Medical Staff Office

1 month ago

Tempe AZ, United States Arizona Complete Health Full time

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.


Analyze and resolve verbal and written claims and authorization grievance/appeals from providers and members. Resolve all State inquires related to complaints, grievances and appeals.
• Review and process member and provider grievances and appeals within federal, state and organizational regulations and policies and procedures
• Review claim grievance for reconsideration and either approve/deny based on determination level or prepare for medical review presentation. Prepare cases for medical review as necessary
• Review and determine if claim grievance includes a potential quality or access issue
• Serve as liaison between member, provider regulatory agencies and internal staff. Education/Experience: Bachelor's degree in related field or equivalent experience. 2+ years of claims, contracting, or related experience in a managed care environment.
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. 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.