Remote Provider Reimbursement & Claims Specialist

Socket.dev; Goshen (CT); On-site; USD 37,000 - 67,000; Full time

Benefits offered by this job

Health insurance

401K

Stock purchase plan

Tuition reimbursement

Paid time off

Holidays

Flexible work arrangements

Job summary

Centene is seeking a healthcare claims professional to maintain relationships with providers and oversee complex claim issues. You will coordinate with Provider Network Management and other internal teams to deliver final resolutions and drive process improvements.

The role includes periodic site visits and monthly impact reporting. Experience with NY state provider fee schedules, IDR processes under the no surprises act, and tri-state area familiarity are preferred.

Qualifications

• Bachelor’s degree in Health Services, Health Care/Hospital Administration or related field.
• Minimum of two years experience in medical claims review and/or claims appeal.

Responsibilities

• Acts as first line contact for providers/hospitals on claims projects and non-routine issues.
• Manages projects with adjusters and regional units for research, analysis and resolution.
• Communicates final resolution to providers and internal teams.
• Performs site visits to providers/physicians/facilities as needed.
• Participates in process improvement and monthly reporting on quality initiatives.

Education

Bachelor’s degree in Health Services/Health Care Administration

Tools

Claims analysis

Job description

Centene is seeking a healthcare claims professional to maintain relationships with providers and oversee complex claim issues. You will coordinate with Provider Network Management and other internal teams to deliver final resolutions and drive process improvements.

The role includes periodic site visits and monthly impact reporting. Experience with NY state provider fee schedules, IDR processes under the no surprises act, and tri-state area familiarity are preferred.