Claims Analyst II

Centene Corporation•Remote-MO, MO

3d•$19 - $33•Hybrid

About The Position

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Requirements

High school diploma or equivalent required
2+ years of health insurance or claims related experience required.
Intermediate PC and Microsoft Office skills
Basic math proficiency required.
Required to successfully complete claims basic training, COB advanced training, and ramp period.
For External Candidates: 3+ years of claims processing required.

Nice To Haves

Associate degree or equivalent experience preferred.
Medical coding knowledge (ICD 9/10, CPT, HCPCS) and public program claims experience preferred.
Experience with Medicaid, Marketplace, or Medicare claims preferred.
Experience with Amisys or Facets preferred.

Responsibilities

Ensure timely processing of complex pending medical claims.
Verify and update information on the submitted claims.
Review work processes to determine reimbursement eligibility.
Ensure payments and/or denials are made in accordance with company practices and procedures.
Process first time claims with added complexity.
Apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied.
Research and determine status of medical related claims.
Resolve claims related to adjustments, provider calls, reconsiderations and appeals.
Communicate with stakeholders’ important information needed for the successful processing of claims with added complexity.
Maintain appropriate records, files, documentation, etc.
Meet and maintain department production and quality standards.
Performs other duties as assigned.
Complies with all policies and standards.