Claims Analyst

Centene; United States; Remote; USD 22,000 - 38,000; Full time

Benefits offered by this job

Remote work

Benefits package

Job summary

Centene is seeking candidates for remote processing of medical claims across the United States. You will verify, apply provider contracts, and determine payment or denial decisions in line with policy.

The role requires a high school diploma and at least 1 year in health insurance claims processing, with proficiency in Microsoft Office and basic math. Medicaid/Medicare knowledge is a plus, and on-the-job training is provided.

Qualifications

• High school diploma or equivalent.
• 1 year of health insurance claims processing or related office experience.
• Proficiency with Microsoft Office applications (Word, Excel).
• Working knowledge of ICD-9/10, CPT, HCPCS, and revenue codes.
• Medicaid or Medicare claims experience 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.
• Complete progressive claims training programs as required.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Basic math

Attention to detail

Communication

Education

High school diploma or equivalent

Tools

Microsoft Office

ICD-9/10, CPT, HCPCS knowledge

Job description

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.

Job Details

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.

Applicants for this job have the flexibility to work remote from home anywhere in the United States.

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

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.

For Claims Business Unit

Ability to successfully complete basic claims training programs within 6 months of hire required.

Pay Range

$15.87 - $27.25 per hour

Company Overview

At Centene, we connect people to the care they need to live healthier lives - and the work you do here makes that impact real every day. You'll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It's work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Benefits

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.

Equal Opportunity Employer

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.

Background Check and Fair Chance

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