Remote Senior Quality Auditor – Claims & Compliance

Centene Corp.; United States; Remote; USD 32,000 - 55,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Remote/Hybrid/Field or Office work

Job summary

Centene Corp. is seeking a data management and audit professional to develop and implement business solutions by researching, auditing, and analyzing provider data and claims processing systems.

The role involves reviewing medical review claims, auditing for cost-saving initiatives, and reporting findings to management. The ideal candidate has a High School Diploma or equivalent with four years of data management experience in automated claims environments; remote work option within the

Qualifications

• High School Diploma or equivalent; some college coursework preferred.
• Four years of general data management experience in an automated claims processing, claims research, or provider maintenance environment.

Responsibilities

• Reviews and supports the claims process for medical review and cost saving initiatives.
• Maintains department statistics, as necessary, for quality improvement indicators, regulatory agencies and certification bodies. Performs routine and moderately complex audits on medical review claims to identify exceptions to established claims adjudication requirements.
• Researches issues from reviewed claims to determine origin and appropriate resolutions.
• Summarizes findings and recommendations in reports for feedback, and distributes to management.
• Communicates with claims department regarding results of audited and/or reviewed claims in order to improve claims processing and resolutions.
• Provides qualified data to incorporate into training programs, policies and procedures.
• Maintains current working knowledge of Health Net products, policies and procedures, contract and benefit plan coding, as well as health insurance industry and regulation and certification standards.

Skills

Data management

Education

High School Diploma or equivalent

Some college coursework

Job description

Centene Corp. is seeking a data management and audit professional to develop and implement business solutions by researching, auditing, and analyzing provider data and claims processing systems.

The role involves reviewing medical review claims, auditing for cost-saving initiatives, and reporting findings to management. The ideal candidate has a High School Diploma or equivalent with four years of data management experience in automated claims environments; remote work option within the