Claims Analyst

Centene Corporation

1d•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. The Position Purpose is to ensure timely processing of pending medical claims, verify and update information on submitted claims, review work processes to determine reimbursement eligibility, and ensure payments and/or denials are made in accordance with company protocols and procedures. Centene is committed to helping people live healthier lives by providing access to high-quality healthcare, innovative programs, and a wide range of health solutions that help families and individuals get well, stay well, and be well.

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
Ability to successfully complete basic claims training programs within 6 months of hire required (For Claims Business Unit)

Nice To Haves

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