Claims Liaison I

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.

Position Purpose: Serve as a liaison between the plan, claims, providers and various departments to effectively identify and resolve claims issues

• Audit check run and send claims to the claims department for corrections
• Identify any system changes and work notify the Plan CIA Manager to ensure its implementation
• Collaborate with the claims department to price pended claims correctly
• Document, track and resolve all plan providers’ claims projects
• Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication
• Identify authorization issues and trends and research for potential configuration related work process changes
• Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes
• Identify potential and documented eligibility issues and notify applicable departments to resolve
• Research the claims on various reports to determine if appropriate to move forward with recovery due to non-covered items being allowed, etc.
• Run claims reports regularly through provider information systems
• Research verbal and written providers’ claims inquiries as needed

For PA H&W only:

• Facilitates the exchange of info between the Grievances, Claims processing, and Provider relations systems.
• Educate contracted and non-contracted providers regarding appropriate claims submission requirements, coding updates, electronic claims transactions and electronic fund transfer, and available CHC-MCO resources
• Communicate with providers to exchange info and to gain feedback regarding appropriate claims submission practices

Education/Experience: High school diploma or equivalent. 3+ years of claims processing, provider billing, or provider relations experience, preferably in a managed care environment. Proficient in Excel, CPC certification and knowledge of provider contracts/reimbursement interpretation preferred.
For PA H&W only: Must perform work within the state of PennsylvaniaPay Range: $21.93 - $37.30 per hour

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.