Claims Research Specialist

Job not on LinkedIn

🔥 17 hours ago

🇺🇸 United States – Remote

💵 $23 - $39 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔬 Research Analyst

👻 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

• Act as a liaison between provider relations, provider services, the health plan and corporate to investigate and resolve claims inquiries • Receive and respond to internal and external claims-related issues • Initiate entry or change of provider-related database information • Complete claims-related research projects • Assist with data integrity responsibilities for the provider claims processing system • Investigate and communicate reimbursement and benefit changes • Educate provider relations, provider services and claims liaisons regarding referral and claims submission policies and procedures • Assist providers with claims submission and payment accuracy issues • Attend state meetings regarding fee schedule and benefit changes • Assist with provider complaints and resolutions regarding claims issues and process claims adjustments • Review Medicaid Bulletins for changes and updates and submit change requests to update the payment system

🎯 Requirements

• High school diploma or equivalent • 3+ years of experience in claims payment processing in government programs • Experience in a managed care environment • Knowledge of claims billing and processing functions • Knowledge of Medicaid benefits and/or customer service • Applicants must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future • Bachelor’s degree preferred

🏖️ 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