Lead Claims Analyst

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🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $23 - $39 / hour

⏰ Full Time

🟠 Senior

📋 Claims Specialist

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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

• Assist in coordinating the day-to-day work function of the assigned claims unit. • Provide technical support to staff, investigate, review and resolve complex issues. • Provide support and oversight to ensure payments and/or denials are made in accordance with company practices and procedures. • Train, mentor and develop claims analysts as a reinforcement of claims training. • Serve as first point of escalation. • Monitor claims quality reviews for accuracy, document results and identify trends and systemic root cause analysis. • Assist in creating workflows for the department and support team members in understanding changes in work processes. • Maintain appropriate records, files, documentation, etc.

🎯 Requirements

• High school diploma or equivalent. • Associate degree or equivalent experience preferred. • 2+ years of claims processing required. • Experience with Medicaid, Marketplace, or Medicare claims required. • Experience using computers and advanced skills in Microsoft Office (Word, Excel, etc.) required. • Ability to perform math functions and reason logically. • Knowledge of ICD-9/10, CPT, HCPCs, revenue codes, and medical terminology required. • Must have successfully completed claims basic training, COB advanced training, and ramp period.

🏖️ 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