Quality Specialist
Company Name:
Centene
## Description
Position Purpose: Review and identify financial, transactional and process errors via routine claims data and production reports for provider operations functional business areas
Conduct procedural and financial audits and rebuttals on configuration requests, claims, credential files and provider data for the Error Review Committee
Provide written documentation to operations management regarding audit results
Collaborate with Plan Claims Liaison to identify system errors and develop work plan to resolve system issues and claim errors
Identify processing errors and develop work processes to reduce errors
Analyze data to ensure adjustments/changes yielded anticipated results
Special projects as assigned
10-20% travel required
## Qualifications
Education/
Experience: High school diploma or equivalent. 3
years of analysis, auditing, or related experience. Knowledge of insurance or managed care products and procedures preferred.
## Job
Job: Quality Assurance
Primary Location: USA-Missouri-Chesterfield
Organization: Home State Health Plan
Schedule: Full-time
Req ID: 1001014Estimated Salary: $20 to $28 per hour based on qualifications.
Centene
## Description
Position Purpose: Review and identify financial, transactional and process errors via routine claims data and production reports for provider operations functional business areas
Conduct procedural and financial audits and rebuttals on configuration requests, claims, credential files and provider data for the Error Review Committee
Provide written documentation to operations management regarding audit results
Collaborate with Plan Claims Liaison to identify system errors and develop work plan to resolve system issues and claim errors
Identify processing errors and develop work processes to reduce errors
Analyze data to ensure adjustments/changes yielded anticipated results
Special projects as assigned
10-20% travel required
## Qualifications
Education/
Experience: High school diploma or equivalent. 3
years of analysis, auditing, or related experience. Knowledge of insurance or managed care products and procedures preferred.
## Job
Job: Quality Assurance
Primary Location: USA-Missouri-Chesterfield
Organization: Home State Health Plan
Schedule: Full-time
Req ID: 1001014Estimated Salary: $20 to $28 per hour based on qualifications.
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