Remote 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

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.