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Claims Research Specialist

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 1166021
Additional Locations Farmington,Missouri,US;Great Falls,Montana,US;Westmont,Illinois,US
Category Claims Operations
Schedule Full-time
Description:

Position Purpose: Perform duties to 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 responsibilities related to data integrity of provider claims processing system.
  • Investigate and communicate reimbursement and benefit changes.
  • Educate provider relations, provider services and claims liaisons regarding policies and procedures related to referrals and claims submission.
  • Assist providers with resolving issues with claims submission and payment accuracy.
  • Attend state meetings with regards to fee schedule and benefit changes.
  • Assist with provider complaints & resolutions regarding claims issues and process claims adjustments.
  • Review all Medicaid Bulletins for changes and updates and submit change requests (CRs) to update payment system.

  • Qualifications:


    Education/Experience: High school diploma or equivalent. Bachelor’s degree preferred. 3+ years of experience in claims payment processing in government programs and experience in a managed care environment. Knowledge of claims billing and processing functions, Medicaid benefits, and/or customer service.

    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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