Senior Quality Auditor

Centene Corporation

. Develop and implement effective business solutions through research, audit, and data and/or business-process analysis .

Posted 10/1/2026full-timeRemote • Missouri • United StatesSenior💰 $23 - $40 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in auditing and validating claims, managing provider data, and conducting thorough research to resolve discrepancies. Proficient in maintaining compliance with health insurance industry standards and effectively communicating findings to enhance claims processing.

Highest-signal resume keywords

Claims AuditingData ManagementHealth Insurance KnowledgeProvider Data ManagementRegulatory Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingData AnalysisAudit DocumentationBenefit Plan CodingClaims Research

Soft Skills

CommunicationProblem-SolvingAttention to Detail

Industry Keywords

Health Net ProductsRegulatory StandardsCertification BodiesEnrollment DiscrepanciesQuality Improvement Indicators

About the role

Key responsibilities & impact

Develop and implement effective business solutions through research, audit, and data and/or business-process analysis
Audit and validate routine pre- and post-payment claims for correct adjudication and compliance
Audit provider data loaded into claims processing systems
Document and report audit results
Research claims and enrollment discrepancies related to provider data
Manage provider-data-management-related projects requiring advanced knowledge of provider files and their relationship to claims processing systems
Review and support the claims process for medical review and cost-saving initiatives
Maintain department statistics for quality improvement indicators, regulatory agencies and certification bodies
Perform routine and moderately complex audits on medical review claims to identify exceptions
Research reviewed-claim issues to determine origins and appropriate resolutions
Summarize findings and recommendations in reports and distribute them to management
Communicate audit and review results to the claims department to improve claims processing and resolutions
Provide qualified data for training programs, policies and procedures
Maintain current working knowledge of Health Net products, policies, procedures, coding, and applicable industry standards

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
High School Diploma or equivalent
Four years general data management experience in an automated claims processing, claims research, or provider maintenance environment
Some college coursework preferred
Working knowledge of Health Net products, policies and procedures
Knowledge of contract and benefit plan coding
Knowledge of health insurance industry, regulation and certification standards
Ability to audit and validate claims
Ability to research claims and enrollment discrepancies related to provider data
Ability to document and report audit results
Ability to work remotely within the continental United States
Preferred schedule based on Central Standard Time or Eastern Standard Time

Benefits

Comp & perks

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