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: Identify, analyze, and resolve provider claims and encounter submission issues. Act as a liaison between the plan, claims, providers and various departments to effectively resolve claims and encounters issues.

• Research and resolve complex provider claims inquiries and pending or denied encounters
• Track trends in claims processing and encounter submission issues, assist in identifying and quantifying solutions, make recommendations, and assist with implementations
• Research and resolve systemic issues that may impact state compliance
• Identify providers experiencing a large number of claims issues or with the potential to develop claims issues and proactively work to eliminate barriers for accurate and timely claims processing
• Establish and monitor prioritization process to reduce backlog of encounters projects
• Assist with reviews and initiate discussion with providers as needed on encounter scrubs and pends
• Lead claim projects, pricing issues and documenting trends for contract implementation on system issues and provider education
• Assist with provision of Medicare coverage and services
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Associate’s degree in Business Administration, Health Care Administration, related field, or equivalent experience. 4+ years of combined claims processing and data analysis or related insurance experience. Lead or supervisory experience preferred.

Pay Range: $55,100.00 - $99,000.00 per year

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