Claims Analyst II

🕒 July 29

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $19 - $32 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

🚫👨‍🎓 No degree required

👻 Ghost score 37%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

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 submitted claims • Review work processes to determine reimbursement eligibility • Ensure payments and denials follow company practices and procedures • Process first-time claims with added complexity • Apply policy and provider contract provisions to determine claim payment, additional information needs, or denial • Research and determine the status of medical-related claims • Resolve claims related to adjustments, provider calls, reconsiderations, and appeals • Communicate important information to stakeholders for successful processing of complex claims • Maintain appropriate records, files, and documentation • Meet and maintain department production and quality standards • Perform other duties as assigned • Comply 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 • External candidates: 3+ years of claims processing required • Intermediate PC and Microsoft Office skills • Basic math proficiency • Medical coding knowledge (ICD 9/10, CPT, HCPCS) preferred • Public program claims experience preferred • Experience with Medicaid, Marketplace, or Medicare claims preferred • External candidates: Experience with Amisys or Facets preferred • Required to successfully complete claims basic training, COB advanced training, and ramp period

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity