Job Information

Centene Corporation Claims Liaison I in Chicago, Illinois

Position Purpose:

Serve as a liaison between the plan, claims, providers and various departments to effectively identify and resolve claims issues

  • Audit check run and send claims to the claims department for corrections

  • Identify any system changes and work notify the Plan CIA Manager to ensure its implementation

  • Collaborate with the claims department to price pended claims correctly

  • Document, track and resolve all plan providers’ claims projects

  • Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication

  • Identify authorization issues and trends and research for potential configuration related work process changes

  • Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes

  • Identify potential and documented eligibility issues and notify applicable departments to resolve

  • Research the claims on various reports to determine if appropriate to move forward with recovery due to non-covered items being allowed, etc.

  • Run claims reports regularly through provider information systems

  • Research verbal and written providers’ claims inquiries as needed


High school diploma or equivalent. 3+ years of claims processing, provider billing, or provider relations experience, preferably in a managed care environment. Proficient in Excel, CPC certification and knowledge of provider contracts/reimbursement interpretation 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.

TITLE: Claims Liaison I

LOCATION: Chicago, Illinois

REQNUMBER: 1233631

COMPANY: Administrative & Operations support