Claims Auditor

🔥 16 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $19 - $32 / hour

⏰ Full Time

🟢 Junior

🔎 Auditor

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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

• Perform routine and moderately complex audits of claims adjudication processes • Identify trends, issues, and exceptions to established claims adjudication requirements • Report quality-standard impacts to management • Identify audit performance trends and patterns and recommend improvements to quality, workflow processes, policies, and procedures • Review and complete contested claims • Research claim processing problems and errors and determine their origin • Provide feedback to examiners, trainers, and management • Manually enter audit data into the database and develop reports from audit findings • Provide coaching and feedback on prepayment and post-payment findings and trends • Recommend additional training or updates to prevent errors and enhance service and productivity within Health Net • Monitor daily assignments and prioritize aged audits to complete audits timely per regulatory and department guidelines • Perform other related duties as assigned

🎯 Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future • High School Diploma required • Minimum one year relevant experience • In-depth experience in Health Care Claims, Contracts, Benefit Application, and Coordination of Benefits • Comprehensive working knowledge of Policies, Procedures, Compliance Regulations, Schedule of Benefits, and turn around times across all product lines • Ability to participate in specialized training within departments

🏖️ Benefits

• 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