Claims Analyst II

Centene Corporation; Missouri; Hybrid; USD 27,000 - 45,000; Full time

Benefits offered by this job

Remote work options

Hybrid work options

Competitive pay

Job summary

Centene Corporation is seeking a claims processor to ensure timely processing of complex medical claims in the United States. The role involves applying policy and contract provisions to determine payability, researching claim status, and resolving adjustments or appeals.

Candidates need 2+ years of health insurer experience and solid computer skills. External candidates should have 3+ years of claims processing and familiarity with Amisys or Facets.

Qualifications

• Health insurance claims processing experience required.
• Proficient in Microsoft Office; basic math skills.
• Medical coding knowledge (ICD-9/10, CPT, HCPCS) preferred.
• Experience with Medicaid, Marketplace, or Medicare claims preferred.
• Must successfully complete claims basic training, COB advanced training, and ramp period.

Responsibilities

• Process first-time claims with added complexity.
• Apply policy and provider contract provisions to determine payability or denial.
• Research and determine status of medical related claims.
• Resolve claims related to adjustments, provider calls, reconsiderations and appeals.
• Communicate with stakeholders about information needed for processing.
• Maintain appropriate records and documentation.
• Meet and maintain department production and quality standards.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Claims processing

Health insurance knowledge

Microsoft Office

Basic math

Medical coding knowledge

Education

High school diploma or equivalent

Associate degree or equivalent experience

Tools

Amisys

Facets

Job description

Position Purpose:

Ensure timely processing of complex 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 practices and procedures.

• Process first time claims with added complexity.
• Apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied.
• Research and determine status of medical related claims.
• Resolve claims related to adjustments, provider calls, reconsiderations and appeals.
• Communicate with stakeholders’ important information needed for the successful processing of claims with added complexity.
• 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.

Education/Experience:

High school diploma or equivalent required; Associate degree or equivalent experience preferred. 2+ years of health insurance or claims related experience required. Intermediate PC and Microsoft Office skills; basic math proficiency required. Medical coding knowledge (ICD 9/10, CPT, HCPCS) and public program claims experience preferred. Experience with Medicaid, Marketplace, or Medicare claims preferred. Required to successfully complete claims basic training, COB advanced training, and ramp period.

For External Candidates:

3+ years of claims processing required. Experience with Amisys or Facets preferred. Required to successfully complete claims basic training, COB advanced training, and ramp period.

Pay Range: $19.43 - $32.98 per hour

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.

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