Job Description

Business Area: Administrative & Claims Operations

Job Type: Full time

Position Purpose: The Recovery Analyst identifies, researches and investigates possible claims overpayments to support the Claims Recovery function.

Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Applicants for this job have the flexibility to work remote from home anywhere in the United States.

One year of claims processing experience or a solid understanding of claims processing preferred.

• Identifies, researches and investigates possible claims overpayments from reports prepared by internal and external sources.

• Determines compliance with benefit plans, provider contracts, and policies and procedures, etc., as they relate to the accuracy of claims payments.

• Summarizes results of research in a meaningful manner that can be used to collect overpayments from providers.

• Interacts with providers regarding collections, adjustments, problems, etc.

• Interacts with outsourced vendors and supports their efforts in the identification of overpayments.

• Reports additional areas where overpayments may have been/are being made noted as a result of performing above work.

• Prepares reports by extracting data in order to be able to investigate additional areas of exposure.

• Controls exception amounts sent directly to providers for collection.

• Reviews cash receipts recorded by Finance for amounts sent in error to other sources.

• Sends timely follow-up letters, records and monitors cash receipts, and issues a report of monthly activity.

• Works with outsourced vendors as required and when receipts are misdirected.

• Interacts with claims adjustment team to ensure adjustment of errors determined during work being performed, especially when reconciliations are required.

• Completes additional responsibilities as required by the department.

• Performs other duties as assigned.

• Complies with all policies and standards.

Education/Experience: Undergraduate degree and/or equivalent experience. Minimum one year experience in a high production, high volume atmosphere.

At Centene, we connect people to the care they need to live healthier lives - and the work you do here makes that impact real every day. You'll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It's work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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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