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Claims Liaison I

IlliniCare Health Plan Burr Ridge, Illinois, Farmington, Missouri, Great Falls, Montana, Westmont, Illinois

As part of the Customer Service department, you’ll use your knowledge of Centene’s insurance products and service to help our members understand their benefits, details and policy procedures. With your skills, you can help transform the health of every community, one person at a time.

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What does it take?

What are the qualities that will help you achieve success in this role at Centene?

Success Profile

  • Detail-oriented
  • Organized
  • Proactive
  • Positive
  • Trustworthy
  • Consistent

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Our Customer Service Roles

Customer Care Opportunities at Centene

Our Customer Service teams work to ensure high levels of service and customer satisfaction. Learn more about this vital group at Centene

Claims Analyst

As part of a tight-knit team and working as a partner to each provider, you’ll evaluate the needs of your health plan and process all claims in accordance with guidelines.

Claims Liaisons

While ensuring that provider and member requests are taken care of, you’ll review requests from providers and work with state health plans to ensure the accuracy and quality of claims.

Customer Service Representative

You’ll use your healthcare knowledge, analytical skills and our information resources to quickly and correctly answer questions from members and providers.

Enrollment Analyst

You’ll process incoming membership files and focus on maintaining the enrollment integrity of our individual health plan systems.

Systems Solutions Manager

While leading a team of business analysts, you’ll work with the IT department to drive end-to-end solutions for core applications supporting Centene’s operations. Claims Analyst.

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Responsibilities

Job ID 1166093
Additional Locations Farmington,Missouri,US;Great Falls,Montana,US;Westmont,Illinois,US
Category Claims Operations
Schedule Full-time
Description:

Position Purpose: Serve as a liaison between the plan, claims, providers and various departments to effectively identify and resolve claims issues

  • Audit check run and send claims to the claims department for corrections
  • Identify any system changes and work notify the Plan CIA Manager to ensure its implementation
  • Collaborate with the claims department to price pended claims correctly
  • Document, track and resolve all plan providers’ claims projects
  • Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication
  • Identify authorization issues and trends and research for potential configuration related work process changes
  • Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes
  • Identify potential and documented eligibility issues and notify applicable departments to resolve
  • Research the claims on various reports to determine if appropriate to move forward with recovery due to non-covered items being allowed, etc.
  • Run claims reports regularly through provider information systems
  • Research verbal and written providers’ claims inquiries as needed


    For PA H&W only:
    Facilitates the exchange of info between the Grievances, Claims processing, and Provider relations systems.
    Educate contracted and non-contracted providers regarding appropriate claims submission requirements, coding updates, electronic claims transactions and electronic fund transfer, and available CHC-MCO resources
    Communicate with providers to exchange info and to gain feedback regarding appropriate claims submission practices

  • Qualifications:


    Education/Experience: High school diploma or equivalent. 3+ years of claims processing, provider billing, or provider relations experience, preferably in a managed care environment. Proficient in Excel, CPC certification and knowledge of provider contracts/reimbursement interpretation preferred.

    For PA H&W only:
    Must perform work within the state of Pennsylvania

    Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

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    Quote

    “Centene has been instrumental in my professional development. I’m pushed in a way that challenges my fears, improve my skills, and enhance my knowledge on healthcare.”

    - Meaghan Hooks, Business Analyst II

    “My job has a direct impact on our providers and members. With every claim paid out the door we are directly helping to save someone’s life!”

    - Jonelle Levy, Business Analyst II

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    Centene is consistently recognized for how well we treat our members, our people, and the communities we serve.

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    “Centene is an exciting company to work for.”

    Esmeralda Baig

    Started as a Case Manager, now a Senior Vice President of Operation

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