Lead Claims Analyst
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.