Remote Senior Quality Auditor – Claims & Compliance

Centene Corp.; United States; Remoto; USD 32.000 - 55.000; Tempo pieno

Descrizione del lavoro

Centene Corp. seeks a Senior Quality Auditor to audit and validate pre and post payment claims, ensuring accurate adjudication and adherence to corporate policies and regulatory standards.

The role involves auditing provider data in claims systems, documenting results, researching discrepancies, and reporting findings to management. Ideal candidates will have four years of data management experience in automated claims processing environments and a high school diploma or equivalent.

Competenze

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

Mansioni

• Audit and validate routine pre and post payment claims to ensure correct adjudication and regulatory compliance.
• Audit provider data loaded into claims processing systems, document results, and report findings to management.
• Identify issues from reviewed claims and determine origin and resolution; summarize findings for training and policy updates.
• Communicate results to claims department to improve processing and resolutions.

Conoscenze

Audit

Data management

Claims processing

Regulatory knowledge

Healthcare policies

Formazione

High School Diploma or equivalent

Strumenti

Claims processing systems

Descrizione del lavoro

Centene Corp. seeks a Senior Quality Auditor to audit and validate pre and post payment claims, ensuring accurate adjudication and adherence to corporate policies and regulatory standards.

The role involves auditing provider data in claims systems, documenting results, researching discrepancies, and reporting findings to management. Ideal candidates will have four years of data management experience in automated claims processing environments and a high school diploma or equivalent.