Work in Iowa Disability Jobs

Job Information

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

Education/Experience:

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

REQNUMBER: 1192731

COMPANY: Administrative & Operations support

POSITION TYPE: Both

DirectEmployers