Claims Analyst I

📋 Description

• • Embark on a vital role within Centene Corporation, a leading healthcare organization dedicated to transforming the health of communities and serving over 28 million members. As a Claims Analyst I, you will be instrumental in ensuring the integrity and accuracy of our claims processing, directly impacting the financial health and member satisfaction of our diverse clientele.
• • This position offers a unique opportunity to contribute to a mission-driven company that values innovation and a fresh perspective on workplace flexibility, with scheduled shifts from Monday to Friday, 9 am to 6 pm, tailored to your local time zone.
• • Your primary responsibility will be the meticulous review of incoming claims to guarantee strict adherence to established claim entry and claim payment policies and procedures. This involves a deep understanding of regulatory requirements and internal guidelines to maintain operational excellence.
• • You will play a crucial part in the efficient release of pended claims, investigating discrepancies and resolving issues to ensure timely processing and payment. This requires a keen eye for detail and the ability to identify root causes of claim holds.
• • A significant aspect of your role will involve processing member receipts, ensuring that all incoming financial documentation is accurately recorded and reconciled. This contributes to the overall financial accuracy of member accounts.
• • You will actively assist in manual claim entry, a critical function for handling complex or non-standard claims that require human intervention. This task demands precision and a thorough understanding of claim data fields.
• • Furthermore, you will be responsible for processing member reimbursements, ensuring that members receive the correct financial compensation in a timely manner, thereby enhancing member trust and satisfaction.
• • Completing claims adjustments will be a key duty, involving the correction of errors, application of adjustments, and ensuring that all claim statuses are accurately reflected in the system. This requires analytical skills to understand the impact of adjustments.
• • You will be expected to consistently meet established quality and production standards. This involves maintaining a high level of accuracy in your work while also managing a significant volume of claims, demonstrating efficiency and effectiveness in your daily tasks.
• • This role provides a foundational experience in healthcare claims analysis, offering exposure to various claim types, coding systems (ICD10/CPT), and the intricacies of healthcare finance and operations.
• • By joining Centene, you become part of an organization committed to diversity and inclusion, where every employee's unique background and perspective are valued. You will contribute to a culture that believes in the power of difference to drive innovation and improve outcomes for all.
• • This position is ideal for individuals who are detail-oriented, possess strong analytical and problem-solving skills, and are eager to learn and grow within the healthcare industry. Your contributions will directly support Centene's mission to transform the health of our communities, one person at a time.