Claims Analyst II

🔥 1 hour ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $19 - $32 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

🚫👨‍🎓 No degree required

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

⚕️ Healthcare Insurance

🤝 Non-profit

🌍 Social Impact

Healthcare Insurance • Non-profit • Social Impact

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Ensure timely processing of complex pending medical claims • Verify and update information on the submitted claims • Review work processes to determine reimbursement eligibility • Ensure payments and/or denials are made in accordance with company practices and procedures • Process first time claims with added complexity • Apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied • Research and determine status of medical related claims • Resolve claims related to adjustments, provider calls, reconsiderations and appeals • Communicate with stakeholders’ important information needed for the successful processing of claims with added complexity • Maintain appropriate records, files, documentation, etc • Meet and maintain department production and quality standards • Performs other duties as assigned • Complies with all policies and standards.

🎯 Requirements

• High school diploma or equivalent required • Associate degree or equivalent experience preferred • 2+ years of health insurance or claims related experience required • Intermediate PC and Microsoft Office skills; basic math proficiency required • Medical coding knowledge (ICD 9/10, CPT, HCPCS) and public program claims experience preferred • Experience with Medicaid, Marketplace, or Medicare claims preferred • Required to successfully complete claims basic training, COB advanced training, and ramp period. • For External Candidates: 3+ years of claims processing required • Experience with Amisys or Facets preferred

🏖️ Benefits

• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules