Remote Claims Policy Analyst

Centene Management Company LLC; Missouri; Hybrid; USD 70,000 - 126,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Remote/Hybrid/Field/Office work styles

Job summary

Centene Management Company LLC is seeking a Payment Integrity policy specialist to evaluate regulatory changes and translate them into claims processing rules. You will collaborate with Medical Affairs, Coding, Compliance, and Claims teams to ensure accurate adjudication.

The role requires a High School diploma and 3+ years in health insurance or related fields; CCS/RHIT/CPC certifications are preferred. Remote work from anywhere in the U.S. is supported, with comprehensive benefits available.

Qualifications

• High School Diploma or GED required; 3+ years in health insurance or claims operations.
• CCS-Certified Coding Specialist or RHIT or CPC or equivalent certification required.

Responsibilities

• Evaluate regulatory changes for applicability to claims processing and required customizations.
• Interpret contractual provisions to ensure correct implementation of benefit, payment, and policy logic within claims workflows.
• Collaborate with Claims Operations and PI Leadership to ensure accuracy and consistency in adjudication outcomes.
• Develop policy summaries, decision documentation, and operational guidance for Claims Operations and related business units.
• Contribute to provider education content when policy changes require external communication.

Skills

Regulatory analysis

Policy interpretation

Cross-functional collaboration

Documentation

Provider education content

Education

High School Diploma or GED

CCS-Certified Coding Specialist

RHIT - Registered Health Information Technician

CPC - Certified Professional Coder

Job description

Centene Management Company LLC is seeking a Payment Integrity policy specialist to evaluate regulatory changes and translate them into claims processing rules. You will collaborate with Medical Affairs, Coding, Compliance, and Claims teams to ensure accurate adjudication.

The role requires a High School diploma and 3+ years in health insurance or related fields; CCS/RHIT/CPC certifications are preferred. Remote work from anywhere in the U.S. is supported, with comprehensive benefits available.