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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 1175386

Category Claims Operations
Schedule Full-time
Description:

Position Purpose: Review high dollar claims for appropriate place of service, length of stay, match to authorization, and possible outlier DRG or Stop Loss pricing. Conduct complex business and operational analyses to assure payments are in compliance with contract; identify areas for improvement and clarification for better operational efficiency.

  • Work collaboratively with various cross-functional departments to determine appropriateness of pricing
  • Work collaboratively with Medical Management Department to resolve any issues with medical review notes that affect high dollar claim pricing
  • Serve as a technical resource / coding subject matter expert for contract pricing related issues
  • Responsible for entire cycle of high dollar claims which includes verifying information on submitted claims, reviewing contracts, compliance guidelines, state regulations, eligibility, and authorizations to determine reimbursement, and releasing claim for payment
  • Identify key elements and processing requirements based on diagnosis, provider, contracts and policies and procedures utilizing broad based product or system knowledge to ensure timely payments are generated.
  • Conduct point of service review and resolution of high dollar claims that are pending and/or adjusted incorrectly including review, investigation, adjustment and resolution of claims, claims appeals, inquiries, and inaccuracies in payment of claims.
  • Collaborate with all departments to analyze complex claims issues and special claim projects which are identified through high dollar review
  • Review inventories to determine appropriate task to complete first and key performance indicators are met
  • Manage and provide testing on new product or system configuration to determine success rate of such product or configuration prior to go-live

  • Qualifications:


    Education/Experience: : High school diploma or equivalent and 3+ years of claims processing, medical billing, administrative, customer service, call center, physician’s office or other office services experience. Previous managed care, State and/or Federal health care programs (i.e., Medicaid, Medicare) or health insurance industry experience. Knowledge of billing practices for hospitals, physicians and/or ancillary providers as well as knowledge about contracting and claims processing.

    Licenses/Certifications: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CSS), Professional Coder-Payer (CPC-P) certification, Certified Professional Coder (CPC) or related certifications preferred.

    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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    Our Awards

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

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    Our Hiring Process

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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

    See Esmeralda's career path

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