Claims Policy Analyst

Centene Corporation

. Evaluate and interpret Payment Integrity policies, federal and state regulations, and contract changes to support compliant and accurate claims adjudication .

Posted 10/8/2026full-timeRemote • Missouri • United StatesMid-LevelSenior💰 $70,100 - $126,200 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in evaluating Payment Integrity policies and federal and state regulations to ensure compliant claims adjudication. Proficient in analyzing operational impacts of regulatory changes and collaborating with cross-functional teams to enhance claims processing accuracy.

Highest-signal resume keywords

Payment Integrity AnalysisClaims Operations ExperienceRegulatory ComplianceCCS CertificationBenefit Configuration

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims AdjudicationPolicy InterpretationOperational Feasibility EvaluationRegulatory AnalysisClaims ConfigurationTesting and Workflow Impact Assessment

Soft Skills

CollaborationFeedback ProvisionCommunication

Certifications & Qualifications

CCS - Certified Coding SpecialistRHIT - Registered Health Information TechnicianCPC - Certified Professional Coder

Industry Keywords

Health InsurancePayment IntegrityClaims ProcessingAuditingFederal RegulationsState Regulations

About the role

Key responsibilities & impact

Evaluate and interpret Payment Integrity policies, federal and state regulations, and contract changes to support compliant and accurate claims adjudication
Analyze regulations, payer contractual requirements, and internal Payment Integrity program changes for impacts on Claims and Configuration Operations
Provide feedback on potential operational impacts or risks from proposed changes
Review federal and state regulatory changes and bulletins for applicability to claims processing and required customizations
Interpret contractual provisions for correct implementation of benefit, payment, and policy logic in claims workflows
Evaluate policy changes for operational feasibility and claims system impact, including configuration, testing, and downstream workflows
Collaborate with Claims and Configuration Operations to validate rule interpretations and adjudication accuracy
Collaborate with PI Leadership, Medical Affairs, vendor partners, Compliance, and Health Plans during pre-implementation
Develop policy summaries, decision documentation, and operational guidance
Contribute to provider education content when policy changes require external communication
Perform other duties as assigned

Requirements

What you’ll need

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
Benefit configuration experience preferred
High School Diploma or GED equivalent required
3+ years of experience in health insurance, claims operations, payment integrity, auditing, or related discipline required
CCS-Certified Coding Specialist required, or RHIT - Registered Health Information Technician required, or CPC - Certified Professional Coder required, or equivalent certification required
Compliance with all policies and standards

Benefits

Comp & perks

Health insurance
401K plan
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Competitive pay
Additional forms of incentives may be included in total compensation