Claims Analyst Refunds

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: Ensure timely processing of provider refunds from medical claims. Verify and update information on provider refund accuracy for the associated claims. Review work processes to determine refund accuracy. Ensure refunds are processed in accordance with company protocols and procedures. Ability to successfully complete additional progressive claims training programs within 12 months of hire.

• Process provider refunds
• Apply policy and provider contract provisions, and review claims to determine if refunds are applied appropriately.
• Research and determine accuracy of medical claims refunds
• Maintain records, files, and documentation as appropriate
• Meet and maintain department production and quality standards
• Successfully complete additional progressive claims training programs as required
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: High school diploma or equivalent. 1 year of health insurance industry, claims processing, physician’s office or other office services experience. Proficiency and experience using computers with Microsoft Office (Word, Excel, etc.). 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.

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