Claims Research Specialist

Position Purpose: Perform duties to act as a liaison between provider relations, provider services, the health plan and corporate to investigate and resolve claims inquiries.

Key Details: Applicants for this position have the flexibility to work remotely from anywhere within the United States. The work schedule is Monday through Friday, from 8:00 a.m. to 5:00 p.m. Eastern Time.

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT.

• Receive and respond to internal and external claims related issues.
• Initiate entry or change of provider related database information.
• Complete claims related research projects.
• Assist with responsibilities related to data integrity of provider claims processing system.
• Investigate and communicate reimbursement and benefit changes.
• Educate provider relations, provider services and claims liaisons regarding policies and procedures related to referrals and claims submission.
• Assist providers with resolving issues with claims submission and payment accuracy.
• Attend state meetings with regards to fee schedule and benefit changes.
• Assist with provider complaints & resolutions regarding claims issues and process claims adjustments.
• Review all Medicaid Bulletins for changes and updates and submit change requests (CRs) to update payment system.

Education/Experience: High school diploma or equivalent. Bachelor’s degree preferred. 3+ years of experience in claims payment processing in government programs and experience in a managed care environment. Knowledge of claims billing and processing functions, Medicaid benefits, and/or customer service.

 

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

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, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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