Claims Analyst

Centene Corporation

21h • $16 - $27 • Hybrid

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. 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. 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.

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 basic claims training programs within 6 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

• 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.
• 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.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees