Senior Medical Claims Analyst

Centene Corporation; Missouri; Hybrid; USD 27,000 - 45,000; Full time

Benefits offered by this job

Remote work options

Hybrid work options

Competitive pay

Job summary

Centene Corporation is seeking a claims processor to ensure timely processing of complex medical claims in the United States. The role involves applying policy and contract provisions to determine payability, researching claim status, and resolving adjustments or appeals.

Candidates need 2+ years of health insurer experience and solid computer skills. External candidates should have 3+ years of claims processing and familiarity with Amisys or Facets.

Qualifications

• Health insurance claims processing experience required.
• Proficient in Microsoft Office; basic math skills.
• Medical coding knowledge (ICD-9/10, CPT, HCPCS) preferred.
• Experience with Medicaid, Marketplace, or Medicare claims preferred.
• Must successfully complete claims basic training, COB advanced training, and ramp period.

Responsibilities

• Process first-time claims with added complexity.
• Apply policy and provider contract provisions to determine payability or denial.
• Research and determine status of medical related claims.
• Resolve claims related to adjustments, provider calls, reconsiderations and appeals.
• Communicate with stakeholders about information needed for processing.
• Maintain appropriate records and documentation.
• Meet and maintain department production and quality standards.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Claims processing

Health insurance knowledge

Microsoft Office

Basic math

Medical coding knowledge

Education

High school diploma or equivalent

Associate degree or equivalent experience

Tools

Amisys

Facets

Job description

Centene Corporation is seeking a claims processor to ensure timely processing of complex medical claims in the United States. The role involves applying policy and contract provisions to determine payability, researching claim status, and resolving adjustments or appeals.

Candidates need 2+ years of health insurer experience and solid computer skills. External candidates should have 3+ years of claims processing and familiarity with Amisys or Facets.