Remote Senior Quality Auditor – Claims & Data Analytics

Centene Corp.; Missouri; Ibrido; USD 32.000 - 55.000; Tempo pieno

Vantaggi offerti da questo lavoro

Benefits package

Descrizione del lavoro

Centene Corp. is seeking an experienced data auditor to develop and implement effective business solutions through research, audit, and analysis of claims and provider data.

This role validates pre and post payment claims to ensure correct adjudication and compliance with policies and regulations. The position supports remote work across the continental United States with preferred schedules aligned to CST or EST.

Competenze

• High School Diploma; some college coursework preferred.
• 4 years general data management experience in automated claims processing, claims research, or provider maintenance environments.

Mansioni

• Reviews and supports the claims process for medical review and cost saving initiatives.
• Maintains department statistics for quality improvement indicators and regulatory bodies.
• Performs routine and moderately complex audits on medical review claims to identify exceptions to adjudication requirements.
• Researches issues from reviewed claims to determine origin and resolutions.
• Summarizes findings and recommendations in reports for management feedback.
• Communicates results to claims department to improve processing and resolutions.
• Provides data to training programs, policies, and procedures.

Conoscenze

Data analysis

Data management

Auditing

Claims processing knowledge

Formazione

High School Diploma

Descrizione del lavoro

Centene Corp. is seeking an experienced data auditor to develop and implement effective business solutions through research, audit, and analysis of claims and provider data.

This role validates pre and post payment claims to ensure correct adjudication and compliance with policies and regulations. The position supports remote work across the continental United States with preferred schedules aligned to CST or EST.