Claims Auditor

Summary

Centene Corporation is a healthcare organization focused on making healthcare more accessible and effective. The Claims Auditor conducts routine and moderately complex audits of claims processes, identifies trends and exceptions, and provides feedback and recommendations to improve quality, compliance, workflow, and productivity.

Responsibilities

• Performs routine and moderately complex audits to identify trends, issues, and exceptions to the established claims adjudication requirements. Reports to management when quality standards impact the business unit, company, affiliates and/or clients and customers
• Proactively identifies performance trends/patterns of audits to management, and makes recommendations to improve quality, workflow processes, policies and procedures
• Provides timely review and completion on all contested claims
• Researches claim processing problems and errors to determine their origin and provides appropriate feedback to examiners, trainers and management
• Manually enters audit data into the database to develop reports based on the audit findings
• Provides coaching and feedback to examiners and management on prepayment and post payment findings and trends
• Provides recommendations for additional training or updates that will help prevent further errors to enhance service and productivity within Health Net
• Maintains a comprehensive working knowledge of Policies, Procedures, Compliance Regulations, Schedule of Benefits and turn around times across all product lines
• Participates in specialized training within departments
• Monitors daily assignments and prioritizes aged audits to ensure all audits are completed timely per regulatory and department guidelines
• Performs other related duties as assigned

Skills

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
• High School Diploma required
• Minimum one year relevant experience
• In-depth experience in Health Care Claims, Contracts, Benefit Application, Coordination of Benefits

Qualifications

Must Haves

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
• High School Diploma required
• Minimum one year relevant experience
• In-depth experience in Health Care Claims, Contracts, Benefit Application, Coordination of Benefits

Benefits

• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• A flexible approach to work with remote, hybrid, field or office work schedules