Centene Corporation Claims System Specialist in Des Moines, Iowa
Position Purpose : Serve as the subject matter expert for claims payment and as a liaison between the plan, claims, various departments and providers to effectively identify and resolve claim issues
Submit change requests (CR) for system changes and test the CRs before production
Run and audit CRs to ensure accurate implementation of change.
Analyze data from audit reports and identify system issues that may need CRs
Review Medicaid updates and ensure the system is set up correctly. Submit CRs for necessary updates to ensure compliance with State Medicaid rules
Collaborate with the claims department to ensure accurate claims processing by assisting in the writing of the work processes
Update and review fee schedule from the State and ensure payment is aligned with fee schedule
Analyze trends in claims processing issues and identify work process solutions
Audit check run and send claims to the claims department for correction. Identify any system changes and ensure its implementation
Work with the claims department at Great Falls to price pended claims correctly
Assist with new system implementation, including testing of claims payments
Bachelor’s degree in related field or equivalent experience. 3+ years of claims processing or provider contract experience in a managed care environment.
For Iowa Total Care plan only: 3+ years of claims processing, provider relations, or contract experience.
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.
TITLE: Claims System Specialist
LOCATION: Des Moines, Iowa
COMPANY: Administrative & Operations support
POSITION TYPE: Both
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