Claims stateside are going to get walloped by the layoffs

I have been in claims for the last 8 years (and this is just speculation on my part based on what I am seeing & have experienced), is that claims stateside are going to get walloped by the layoffs. We are constantly asking for work (and I am in adjustments) because they are sending it all offshore. This has been happening since late 2020, intending to automate most if not all claims operations and outsource adjustments to the global team ( even though we are constantly fixing their mistakes because Centene will not spare a penny to get them the correct training (which is below subpar even stateside) or the tools they need to do the work correctly. Whoever is handling these projects - I don't know what they are doing - recouping monies we should never have taken back, denying claims that should never have been denied - not to mention the extraordinary amount of mistakes by the system (or the BOT as they like to call it) itself. But hey, when you take the cheapest route, this is what you get, I guess.

Bumping this up for visibility. OP: @ds+1k13qhsem

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@d5 the external contractors are absolutely working on actual Medicaid claims now.

I work Medicaid and marketplace, and while seeing those external contractors, all over marketplace is expected, I’m seeing their hands on Medicaid claims resulting in the claims either not being processed correctly, or just being held to the point where we’re about to get hit with fines.

This has been escalated to Management numerous times, and absolutely nothing has been done about it.

I work Medicaid in 8 different states, Texas is one of them. It was my understanding that Medicaid could not be offshored because it is federally regulated. Unless all these external contractors based in India are somehow magically here in the USA then I would have to say they figured out some loophole. Maybe they aren't processing directly but just running BOTS, which would be 1 way of getting around it and would explain all the massive system errors and endless projects.

there are multiple states, Texas for example, with contracts that specifically prohibit offshoring.

Thread regarding Centene Corp. layoffs

Claims stateside are going to get walloped by the layoffs

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