Company

Centene Corporation

Description

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 Perform front end operational audits and assist in the development of value added feedback regarding the potential negative impact to claims accuracy. Investigate and report conflicts and/or variances of operational processing guidelines that are not compliant with state regulations and/or executed provider contracts.

Research statutory requirements and ensure compliance of all operations that impact claim accuracy.
Conduct audit interviews with front line staff in all functional areas that fall under claim operations.
Test, create flow charts and map operational processes that touch the outcome of claims accuracy.
Evaluate internal processes and/or controls to identify non-compliance issues and improvement opportunities.
Create audit memos to document audit findings, which will result in audit recommendations, reports and claims audit criteria enhancements.

Education/Experience Associate’s degree in Audit, Accounting, related field, or equivalent experience. 2+ years of auditing or accounting experience. Knowledge of claims processing systems and the ability to interpret state and provider contracts.

Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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.

Identifier

5625832c7cbe731328f7ec0b68d538c8