Claims Analyst

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.
 

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.

* Hours - Ability to start work as early as 6:30 a.m. local time and complete their workday within an eight-hour shift. During the first four weeks, schedules may need to be adjusted to align with the training team's requirements.

* Remote based position with a preference for Eastern and Central Time Zones.

* Preferred: Candidates with experience using the Amisys and/or Xcelys platforms.

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

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

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.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act