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.
Position Purpose: Performs data analysis and provider profiling to determine recovery opportunities for claims that are overpaid due to retroactive member termination, inappropriate coding, duplication of payments, non-authorized services, erroneous contract or fee schedule reimbursement, non-covered benefit(s) and other reasons. Provide recommendations to reduce future occurrences of overpayments.
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Acts as team lead on large projects requiring coordination with multiple departments within and outside the company.
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Analyzes contractual obligations and identifies/pursues overpayments on claims for various reasons.
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Prepares detailed analyses on mis-paid claims with complex business requirements and partners with IT resources for data pulls, analysis, and validation.
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Assists in designing and implementing relational data structures related to overpayment issue.
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Summarizes information for business partners for review and resolution and provides recommendations on recovery strategies.
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Monitors progress of overpayment projects and executes on next step.
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Develops comprehensive and detailed analyses on erroneous payments in order to support the revenue collection and reconciliation process.
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Develops complex data queries to generate reports of overpaid claims.
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Mentors junior recovery analysts.
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Ownership and oversight of specific recovery processes.
Required or equivalent work experience: Required 5+ years of experience in Business criteria development. Required 5+ years of experience in Claims processing, Claims Operations or Claims recovery. Experience working in Xcelys, Amisys and ABS preferred.
Pay Range: $68,700.00 - $123,700.00 per year
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
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