Claims Policy Analyst

Job not on LinkedIn

🔥 0 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

👻 Ghost score 0%

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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

• Evaluate and interpret Payment Integrity policies, federal and state regulations, and contract changes to support compliant and accurate claims adjudication • Analyze regulations, payer contractual requirements, and internal Payment Integrity program changes for impacts on Claims and Configuration Operations • Provide feedback on potential operational impacts or risks from proposed changes • Review federal and state regulatory changes and bulletins for applicability to claims processing and required customizations • Interpret contractual provisions for correct implementation of benefit, payment, and policy logic in claims workflows • Evaluate policy changes for operational feasibility and claims system impact, including configuration, testing, and downstream workflows • Collaborate with Claims and Configuration Operations to validate rule interpretations and adjudication accuracy • Collaborate with PI Leadership, Medical Affairs, vendor partners, Compliance, and Health Plans during pre-implementation • Develop policy summaries, decision documentation, and operational guidance • Contribute to provider education content when policy changes require external communication • Perform other 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 • Benefit configuration experience preferred • High School Diploma or GED equivalent required • 3+ years of experience in health insurance, claims operations, payment integrity, auditing, or related discipline required • CCS-Certified Coding Specialist required, or RHIT - Registered Health Information Technician required, or CPC - Certified Professional Coder required, or equivalent certification required • Compliance with all policies and standards

🏖️ 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 • Competitive pay • Additional forms of incentives may be included in total compensation