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.

• Applicants for this job have the flexibility to work remote from home anywhere in the United States

Position Purpose: Assist in reviewing investigating, adjusting and resolving complex claims, claims appeals, inquiries, and inaccuracies in payment of claims. Also, responsible for training claims research specialists and CG&A coordinators also providing claims and authorization education to the appeals nurse.

• Complete claims related research projects
• Initiate entry or change of provider related database information
• Assist in reviewing investigating, adjusting and resolving complex claims, claims appeals, inquiries, and inaccuracies in payment of claims
• Provide training and performance of audits
• Educate provider relations, provider services and claims liaisons regarding policies and procedures related to referrals and claims submission

Education/Experience: High school diploma or equivalent. Bachelor’s degree preferred. 4+ 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. Strong communication skills, root cause analysis and issue resolution highly preferred. Experience with Xcelys, Amisys, or similar claims systems highly preferred.

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. Total compensation may also include additional forms of incentives.

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