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Centene Corporation Claims Business Analyst in Detroit, Michigan

Position Purpose:

  • Audit check run and send claims to the claims department for corrections. Collaborate with the claims department to price pended claims correctly. Identify authorization issues and trends and research for potential configuration related work process changes.

  • Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication. Document, track and resolve all plan providers’ claims projects. Research the claims on various reports to determine if appropriate to move forward with recovery.

  • Lead meetings with various departments to assign claim project priorities and monitor days in step processes to ensure the projects stay on track.

  • Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of new systems.

  • Perform detailed analysis on assigned projects, recommend potential business solutions and assist with implementation. Identify and analyze user requirements, procedures, and problems to improve existing processes.

Education/Experience:

  • High school diploma or equivalent experience.

  • Bachelor’s degree in related field preferred.

  • 3+ years of claims experience required.

  • 0-2 years of business process analysis or data analysis experience preferred.

  • 5+ years of claims processing, providing billing or provider relations experience pin managed care environment preferred.

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 Business Analyst

LOCATION: Detroit, Michigan

REQNUMBER: 1197889

COMPANY: Administrative & Operations support

POSITION TYPE: Both

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