Claims Analyst II

Centene Corporation

1d • Hybrid

About The Position

Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: 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.

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 health insurance industry experience, including claims processing, physician office, or related administrative experience required.
• Required to successfully complete claims basic training, COB advanced training, and ramp period.

Nice To Haves

• Associate degree or equivalent experience preferred.
• Medical coding knowledge (ICD 9/10, CPT, HCPCS)
• 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.

Benefits

• competitive pay
• health insurance
• 401K
• stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules.

What This Job Offers

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