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.

This role can be performed anywhere in the US.

Position Purpose: Assist in coordinating the day-to-day work function of the assigned claims unit, provide technical support to staff, and investigate, review and resolve complex issues

• Assist in reviewing investigating, adjusting and resolving complex claims, claims appeals, inquiries, and inaccuracies in payment of claims.
• Oversee claims quality reviews for accuracy, document results and identify trends and systemic root cause analysis.
• Assist in creating work flows for the department and support team members in understanding changes in work processes.
• Primary contact for the team, for the plan and for other departments in researching, collecting background information and documentation, to address various issues.
• Assists supervisor to research and determine status of medical claims to assure billed dollars, claims aging, and pend values are consistent with contract provisions.
• Maintains records and reports as assigned.
• Assist in meeting departmental production and quality standards.
• May process claims when needed.

Education/Experience: High school diploma or equivalent. 2+ years of claims processing, medical billing, administrative, customer service, call center, or other office services experience. Experience operating a 10-key calculator and computers. Ability to perform basic math functions and reason logically. Knowledge of ICD-9, CPT, HCPCs, revenue codes, and medical terminology. Experience with Medicaid or Medicare claims preferred.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.