• Senior Recovery Analyst

    Centene Corporation (Sacramento, CA)


    You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.

     

    **Position Purpose:** The Senior Recovery Analyst makes recommendations to management after identifying, researching, and investigating possible claims overpayments and by proactively identify claims errors. Directly responsible for maintaining databases, ensuring the quality of data therein, and maintaining published compliance requirements.

    + Identifies, researches and investigates complex requests and possible claims overpayments, underpayments, contract issues, stop losses, etc. from reports prepared by internal and external sources.

    + Prepares reports by extracting data in order to be able to investigate additional areas of exposure, and make appropriate recommendations to management.

    + 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 and makes appropriate recommendations to Management.

    + Recommends and creates policies and procedures.

    + Participated in special projects.

    + Maintains SOX controls and compliance.

    + Participate in auditing and testing.

    + Performs other duties as assigned.

    + Complies with all policies and standards.

    **Education/Experience:** Undergraduate degree and/or equivalent experience. Minimum three years claims payment experience.Pay Range: $22.79 - $38.84 per hour

     

    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