Lead Claims Analyst

Centene Corporation•Remote-FL, FL

1d•$23 - $40•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. This position assists in coordinating the day-to-day work function of the assigned claims unit, provides technical support to staff, and investigates, reviews, and resolves complex issues. The role provides support and oversight to ensure payments and/or denials are made in accordance with company practices and procedures.

Requirements

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
High school diploma or equivalent.
2+ years of claims processing required.
Experience with Medicaid, Marketplace, or Medicare claims required.
Experience using computers and advanced skills in Microsoft Office (Word, Excel, etc.) required.
Ability to perform math functions and reason logically.
Knowledge of ICD-9/10, CPT, HCPCs, revenue codes, and medical terminology required.
Must have successfully completed claims basic training, COB advanced training, and ramp period.

Nice To Haves

Associate degree or equivalent experience preferred.

Responsibilities

Provide oversight and support to ensure that Claims Analysts apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied.
Train, mentor and develop claims analysts as a reinforcement of claims training.
Assist in reviewing, investigating, adjusting, and resolving all pending claims; especially complex claims, claims appeals, inquiries, and inaccuracies in payment of claims. Serve as first point of escalation.
Monitor claims quality reviews for accuracy, document results and identify trends and systemic root cause analysis.
Assist in creating workflows for the department and support team members in understanding changes in work processes.
Serve as primary contact for the team, for the plan and for other departments in researching, collecting background information and documentation, to address various issues.
May actively process claims when needed / Backup to supervisor.
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.