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Centene Corporation Healthcare Configuration and Claims Analyst in Lexington, Kentucky

Position Purpose:

The Operations Configuration and Integration Analyst creates, updates, and maintains system configuration tables and files to support accurate claims adjudication in a multiple product managed care environment.

Job Profile Summary:

  • Analyzes, interprets, and maintains configurable tables, files and software that are utilized to support claim adjudication which include and but are not limited to; claim adjudication rules edits, benefit plan support, and provider reimbursement rules.

  • Assists in development and execution of testing scenarios. Performs unit and/or end user testing for new configuration, new provider contracts, and software changes as necessary that effects claim adjudication rules.

  • Proactively identifies opportunities and recommends system solutions that increase automation, resolves system deficiencies and enhance claims processing to meet and exceed business requirements. Stays abreast of company business strategies and marketplace trends to ensure business decisions meet future needs.

  • Researches and resolves claim problems or issues that are configuration related in a timely and accurate manner.

  • Assist with conducting meetings with functional areas to resolve configuration and operational errors that impact claims adjudication.

  • Develops and maintains a comprehensive knowledge of the claims adjudication rules, claims processing programs and claim related software packages that are utilized in claims adjudication.

Education/Experience:

Bachelor’s Degree or an equivalent combination of education and experience in a managed care environment. Minimum two to three years experience in an automated medical claims environment and managed care/multiple product environment desired. Minimum one to two years experience in systems logic and testing desired

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: Healthcare Configuration and Claims Analyst

LOCATION: Lexington, Kentucky

REQNUMBER: 1230718

COMPANY: Administrative & Operations support

POSITION TYPE: Both

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