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You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose:

Maintain accurate enrollment and membership records within core internal systems related to qualifications for coverage under contracts or agreements and resolve related issues.

+ Review and audit member set ups within business systems to ensure compliance in alignment to State requirements which impact claim adjudication and member’s access to care.

+ Research and respond to any member eligibility inquiries from internal teams, state/member complaints and State agencies.

+ Carry out in-depth analysis to identify root cause and carry out any data updates necessary to resolve issues, discrepancy or manual updates.

+ Communicate resolution/findings on complex eligibility inquiries and state complaints across multiple internal departments timely and effectively.

+ Provide assistance in resolving claim denials, pended claims, high dollar claims and claims recoupment that could result in eligibility updates.

+ Maintain high level of accuracy to minimize or eliminate incorrect authorization, claim denial/payment and/or access to care issues for member.

+ Provide cross training and guidance to departmental staff.

+ Performs other duties as assigned

+ Complies with all policies and standards

Education/Experience:

High school education or equivalent. Bachelor’s degree preferred. 4+ years of member enrollment, membership eligibility records, member services or data analysis experience or Bachelor's degree and 1+ years of related experience. Previous experience in a managed care environment with provider information systems preferred. Experience with data management, reporting/analysis and data administration.

Pay Range: $19.04 - $32.35 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