Claims Analyst

Centene Corporation•Northampton, MA

2d•$16 - $27•Remote

About The Position

You could be the one who changes everything for our 28 million members. 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. Applicants for this job have the flexibility to work remote from home anywhere in the United States. Position Purpose: Ensure timely processing of 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 protocols and procedures.

Requirements

High school diploma or equivalent.
1 year of health insurance industry, claims processing, physician’s office or other office services experience.
Proficiency and experience using computers with Microsoft Office (Word, Excel, etc.).
Ability to perform basic math functions.
For Claims Business Unit: Ability to successfully complete additional progressive claims training programs within 12 months of hire required.

Nice To Haves

Working knowledge of ICD-9/10, CPT, HCPCs, revenue codes, and medical terminology preferred.
Experience with Medicaid or Medicare claims preferred.

Responsibilities

Process first time claims
Apply policy and provider contract provisions to determine if claim is payable
Research and determine status of medical related claims
Maintain records, files, and documentation as appropriate
Meet and maintain department production and quality standards
Successfully complete additional progressive claims training programs as required
Performs other duties as assigned
Complies with all policies and standards