Remote Claims Policy and Compliance Analyst

Centene Corporation; Missouri; Hybrid; USD 70,000 - 126,000; Full time

Job summary

Centene Corporation is seeking a policy interpretation expert to evaluate and implement payment integrity changes affecting claims. You will analyze federal/state regulations, payer contracts, and internal policy updates to mitigate operational risks and ensure accurate adjudication.

The role requires collaborative work with Medical Affairs, Coding, Compliance, and Claims operations. The ideal candidate has 3+ years in health insurance/payments and holds CCS/RHIT/CPC or equivalent certification.

Qualifications

• 3+ years of experience in health insurance, claims operations, payment integrity, auditing, or related discipline.
• Licensing/certification as CCS, RHIT or CPC (or equivalent) is required.

Responsibilities

• Review Federal and State regulatory changes to determine applicability to claims processing.
• Interpret contract provisions to ensure correct benefit, payment, and policy logic.
• Evaluate policy changes for operational feasibility and system impact.
• Collaborate with Claims and Configuration Operations to validate rule interpretations.
• Support pre-implementation efforts with PI Leadership, Medical Affairs, Compliance, and partners.
• Develop policy summaries and operational guidance for Claims Operations.
• Contribute to provider education content when policy changes require external communication.

Skills

Regulatory compliance

Policy analysis

Cross-functional collaboration

Attention to detail

Education

High School Diploma or GED

CCS-Certified Coding Specialist

RHIT - Registered Health Information Technician

CPC - Certified Professional Coder

Job description

Centene Corporation is seeking a policy interpretation expert to evaluate and implement payment integrity changes affecting claims. You will analyze federal/state regulations, payer contracts, and internal policy updates to mitigate operational risks and ensure accurate adjudication.

The role requires collaborative work with Medical Affairs, Coding, Compliance, and Claims operations. The ideal candidate has 3+ years in health insurance/payments and holds CCS/RHIT/CPC or equivalent certification.