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Lead Claims Analyst

Company: Centene Corporation
Location: Rancho Cordova
Posted on: June 6, 2021

Job Description:

Position Purpose: Assist in coordinating the day-to-day work function of the assigned claims unit, provide technical support to staff, and investigate, review and resolve complex issues

Assist in reviewing investigating, adjusting and resolving complex claims, claims appeals, inquiries, and inaccuracies in payment of claims

Oversee claims quality reviews for accuracy, document results and identify trends and systemic root cause analysis

Assist in creating work flows 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.

Assists supervisor to research and determine status of medical claims to assure billed dollars, claims aging, and pend values are consistent with contract provisions.

Maintains records and reports as assigned

Assist in meeting departmental production and quality standards

May process claims when needed

Education/Experience: High school diploma or equivalent. 2 years of claims processing, medical billing, administrative, customer service, call center, or other office services experience. Experience operating a 10-key calculator and computers. Ability to perform basic math functions and reason logically. Knowledge of ICD-9, CPT, HCPCs, revenue codes, and medical terminology. Experience with Medicaid or Medicare claims 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.

Keywords: Centene Corporation, Rancho Cordova , Lead Claims Analyst, Other , Rancho Cordova, California

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