Claims Analyst 2 - 120060

• Organize and manage detailed office or warehouse records using computer systems to enter, access, search, and retrieve data.
  
• Prepare and review insurance claim forms and related documents for completeness.
  
• Provide customer service by giving limited instructions on claim procedures or providing referrals to other facilities or contractors.
  
• Review claims to determine coverage under policies, evaluate settlement extent, and authorize payments.
  
• Set reserves on payments, ensure timely disbursement of funds, coordinate or conduct claim investigations, identify claims with possible recovery from third parties, and consult with attorneys, doctors, and agents regarding complex claim dispositions.
  

• Required: High school diploma or GED.
  
• Preferred: Bachelor's degree in Business or related field.
  
• Experience: 2-4 years of relevant experience.
  

• Schedule: Monday-Friday, 8:00 AM - 5:00 PM.
  
• Overtime: May be required depending on workload.
  

• This is not a field-based or member-facing role.
  

• The worker will not be working in a Centene facility or worksite.
  

• Required: High school diploma or equivalent.
  
• Experience: Minimum 1 year of experience in the health insurance industry, claims processing, physician's office, or other related office services.
  
• Proficiency with Microsoft Office (Word, Excel, etc.) and ability to perform basic math functions.
  
• Working knowledge of ICD-9/10, CPT, HCPCs, revenue codes, and medical terminology preferred.
  
• Experience with Medicaid or Medicare claims preferred.
  

• Claims refer to dental and/or vision claims.
  
• Experience processing dental or vision claims preferred.
  
• Working knowledge of ICD-9/10, CDT, and dental terminology preferred.
  
• Experience with Medicaid or Medicare claims preferred.
  

• Ability to successfully complete progressive claims training programs within 12 months of hire required.
  

• Process first-time claims.
  
• Apply policy and provider contract provisions to determine claim payability.
  
• Research and determine the status of medical-related claims.
  
• Maintain records, files, and documentation as appropriate.
  
• Meet and maintain department production and quality standards.
  
• Successfully complete additional progressive claims training as required.
  
• Perform other duties as assigned.
  
• Comply with all company policies and standards.
  

• Purpose of the Team: The adjustment team is responsible for reprocessing claims that were previously paid or denied incorrectly. Requests are received via the Track-It application.
  
• Team Environment: The team communicates effectively, maintains strong collaboration, and provides constructive feedback (both positive and negative).
  

• Manage multiple tasks as workloads vary daily.
  
• Work on adjusted claims via Track-It and Risk Manager applications, apply refund checks, handle projects, and process reports.
  
• Ensure all items are completed prior to closeout days (Mondays and Wednesdays).
  
• Maintain a 97% quality and 100% production standard.
  
• Participate in onboarding activities including team introductions, system training, compliance courses, and individualized assignment training.
  
• Work fully remote within a cross-trained, collaborative team environment.
  

• Required: High School Diploma.
  
• Preferred: -
  

• Required: N/A
  
• Preferred: -
  

• Minimum 1 year of experience in the health insurance industry, claims processing, physician's office, or other office services experience.
  

• Experience with VLOOKUP and Pivot Tables preferred.
  
• Must be located within the Eastern Time Zone (EST) for remote work.
  

Interested candidates please send resume in Word format Please reference job code 245142 when responding to this ad.