Centene Corporation Claims Examiner I (Operations) in Rancho Cordova, California


Position Purpose: Under close supervision, this position processes routine claims within a single product line to determine type and amount of benefit payable. Performs limited duties, subject to review and approval, for the processing of such claims assigned, consistent with applicable policies, procedures and department guidelines.

  • Determines level of reimbursement based on established criteria, provider contract, plan and employer group provisions.
  • Processes all claims eligible or ineligible for payment accurately and conforming to quality, production standards and specification.
  • Matches authorizations to claims, maintains current desk procedural and reference materials.
  • Reviews appeals and complaints; researches any missing or required information.
  • Responds by telephone or in writing to providers, members, or other company departments to process and resolve the claim issue. Qualifications: Education/Experience: High School diploma or equivalent required. Minimum six months claims examining experience or completion of a technical class specializing in claims processing required. Experience working with Microsoft applications is preferred.] 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. Job: Claims Operations Organization: Federal Services Location: California-Rancho Cordova Requisition ID: CEN1054988-10