Remote Pharmacy Claims Auditor

Centene Management Company LLC; United States; Hybrid; USD 27,000 - 45,000; Full time

Job summary

Centene Management Company LLC is seeking a Claims Auditor to perform quality audits across claims processes, identifying trends and suggesting improvements to management. The role requires a High School Diploma and at least one year of relevant experience in health care claims.

The position involves reviewing contested claims, coaching examiners, and maintaining audit data to generate reports. Flexible schedules with remote/hybrid options are noted, and compensation ranges are provided in the

Qualifications

• High School Diploma required.
• Minimum one year relevant experience in Health Care Claims or related areas.
• Experience with claims processing or benefit applications is a plus.

Responsibilities

• Performs routine and moderately complex audits to identify trends, issues and exceptions to claims adjudication requirements.
• Proactively identifies performance trends and makes recommendations to improve quality and processes.
• Provides timely review and completion on contested claims.
• Researches claim problems to determine origin and feedback to examiners and management.
• Manages audit data entry to develop reports based on findings.
• Provides coaching on prepayment and post payment findings and trends.

Skills

Auditing

Quality assurance

Healthcare claims

Data entry

Coaching

Education

High School Diploma

Tools

Database entry

Job description

Centene Management Company LLC is seeking a Claims Auditor to perform quality audits across claims processes, identifying trends and suggesting improvements to management. The role requires a High School Diploma and at least one year of relevant experience in health care claims.

The position involves reviewing contested claims, coaching examiners, and maintaining audit data to generate reports. Flexible schedules with remote/hybrid options are noted, and compensation ranges are provided in the