Lead Claims Analyst

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Position Purpose:
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.

• Provide oversight and support to ensure that Claims Analysts apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied

• Train, mentor and develop claims analysts as a reinforcement of claims training

• Assist in reviewing, investigating, adjusting, and resolving all pending claims; especially complex claims, claims appeals, inquiries, and inaccuracies in payment of claims. 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

• Primary contact for the team, for the plan and for other departments in researching, collecting background information and documentation, to address various issues

• May actively process claims when needed / Backup to supervisor

• Maintain appropriate records, files, documentation, etc.

• Meet and maintain department production and quality standards

• Performs other duties as assigned

• Complies with all policies and standards

Education/Experience:
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.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act