Claims Research Specialist

Centene Corp.; Northern (KY); Hybrid; USD 32,000 - 55,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K

Tuition reimbursement

Paid time off

Flexible work arrangements

Job summary

Centene Corp. is seeking a Claims Payment Specialist to serve as a liaison among provider relations, services, and health plans. The role focuses on investigating and resolving claims inquiries while supporting data integrity in the claims processing system.

Ideal candidates have 3+ years in government program claims, knowledge of Medicaid benefits, and experience in managed care. This remote-friendly position is Monday–Friday, 8:00 a.m.–5:00 p.m. ET with eligibility to work in the U.S.

Qualifications

• 3+ years of experience in claims payment processing in government programs.
• Knowledge of Medicaid benefits and billing.
• Experience in a managed care environment.

Responsibilities

• Receive and respond to internal and external claims related issues.
• Initiate entry or change of provider related database information.
• Complete claims related research projects.
• Assist with data integrity of provider claims processing system.
• Investigate and communicate reimbursement and benefit changes.
• Educate provider relations, provider services and claims liaisons on policies and procedures related to referrals and claims submission.
• Assist providers with resolving issues with claims submission and payment accuracy.
• Attend state meetings regarding fee schedules and benefit changes.
• Assist with provider complaints and resolutions regarding claims issues and process claims adjustments.
• Review Medicaid Bulletins for changes and submit change requests to update payment systems.

Skills

Claims processing

Customer service

Data integrity

Policy understanding

Education

Bachelor’s degree preferred

High school diploma or equivalent

Tools

Claims processing software

Job description

Position Purpose

Perform duties to act as a liaison between provider relations, provider services, the health plan and corporate to investigate and resolve claims inquiries.

Key Details

Applicants for this position have the flexibility to work remotely from anywhere within the United States.

The work schedule is Monday through Friday, from 8:00 a.m. to 5:00 p.m. Eastern Time.

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.

Responsibilities

• Receive and respond to internal and external claims related issues.
• Initiate entry or change of provider related database information.
• Complete claims related research projects.
• Assist with responsibilities related to data integrity of provider claims processing system.
• Investigate and communicate reimbursement and benefit changes.
• Educate provider relations, provider services and claims liaisons regarding policies and procedures related to referrals and claims submission.
• Assist providers with resolving issues with claims submission and payment accuracy.
• Attend state meetings with regards to fee schedule and benefit changes.
• Assist with provider complaints & resolutions regarding claims issues and process claims adjustments.
• Review all Medicaid Bulletins for changes and updates and submit change requests (CRs) to update payment system.

Education & Experience

• High school diploma or equivalent.
• Bachelor’s degree preferred.
• 3+ years of experience in claims payment processing in government programs and experience in a managed care environment.
• Knowledge of claims billing and processing functions, Medicaid benefits, and/or customer service.

Pay

Pay Range: $23.23 - $39.61 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

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• 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. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.