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Centene Corporation is a healthcare and insurance company focused on government-sponsored coverage and community health. Its services include Medicaid, Medicare, Health Insurance Marketplace plans, and TRICARE support for military communities. Centene combines localized care delivery with partnerships with nonprofit organizations to address the needs of the members it serves. The company also incorporates environmental responsibility and ethical governance into its approach to operating and supporting communities.
Claims Auditor - Florida (Remote)
Audit healthcare claims for accuracy, compliance, and process quality in a remote Florida role with Centene. Investigate exceptions and disputed claims, identify trends, and help improve claims adjudication.
Description
- Conduct routine and moderately complex audits of claims adjudication processes
- Detect trends, issues, and exceptions against established claims adjudication requirements
- Communicate quality-standard impacts to management
- Analyze audit patterns and recommend improvements to quality, workflows, policies, and procedures
- Review and resolve contested claims
- Investigate claims-processing problems and errors to determine their root causes
- Share feedback with examiners, trainers, and management
- Enter audit data into the database and prepare reports based on audit findings
- Coach and provide feedback on prepayment and post-payment findings and trends
- Recommend training or process updates to reduce errors and improve Health Net service and productivity
- Track daily assignments and prioritize aging audits to meet regulatory and departmental deadlines
- Perform other related duties as assigned
Requirements
- U.S. work authorization is required without current or future employment-based visa sponsorship
- High school diploma required
- At least one year of relevant experience
- In-depth knowledge of healthcare claims, contracts, benefit applications, and coordination of benefits
- Broad working knowledge of policies, procedures, compliance regulations, schedules of benefits, and turnaround times across product lines
- Ability to complete specialized departmental training
Benefits
- Health insurance
- 401(k) plan
- Employee stock purchase plans
- Tuition reimbursement
- Paid time off and holidays
- Flexible remote, hybrid, field, or office work arrangements
- Additional incentives may form part of total compensation
- Centene is an equal opportunity employer committed to diversity
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