Remote Claims Quality Auditor

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

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Flexible work arrangements

Job summary

Centene Corporation is seeking a Claims Auditor to ensure quality audits across claims processes, delivering feedback on exceptions and trends to management. The role emphasizes identifying improvement opportunities in workflows, policies, and procedures to drive higher quality service.

The position requires a High School Diploma and at least one year of related experience in health care claims, contracts, and benefit coordination. Authorization to work in the U.S.

Qualifications

• High School Diploma required. Minimum one year relevant experience.
• In-depth experience in Health Care Claims, Contracts, Benefit Application, Coordination of Benefits.

Responsibilities

• Performs routine and moderately complex audits to identify trends, issues, and exceptions to the established claims adjudication requirements.
• Reports to management when quality standards impact the business unit, company, affiliates and/or clients and customers.
• Proactively identifies performance trends/patterns of audits to management, and makes recommendations to improve quality, workflow processes, policies and procedures.
• Researches claim processing problems and errors to determine their origin and provides appropriate feedback to examiners, trainers and management.
• Manually enters audit data into the database to develop reports based on the audit findings.
• Provides coaching and feedback to examiners and management on prepayment and post payment findings and trends.
• Provides recommendations for additional training or updates that will help prevent further errors to enhance service and productivity within Health Net.
• Maintains a comprehensive working knowledge of Policies, Procedures, Compliance Regulations, Schedule of Benefits and turn around times across all product lines.
• Participates in specialized training within departments.
• Monitors daily assignments and prioritizes aged audits to ensure all audits are completed timely per regulatory and department guidelines.
• Performs other related duties as assigned.

Job description

Centene Corporation is seeking a Claims Auditor to ensure quality audits across claims processes, delivering feedback on exceptions and trends to management. The role emphasizes identifying improvement opportunities in workflows, policies, and procedures to drive higher quality service.

The position requires a High School Diploma and at least one year of related experience in health care claims, contracts, and benefit coordination. Authorization to work in the U.S.