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Director, Operations - Ambetter

Pittsburgh, Pennsylvania Apply Now Job ID 1174868 Additional Locations US,Pennsylvania;Harrisburg Category Health Insurance Operations Organization Pennsylvania Health and Wellness Schedule Full-time

The Director, Operations Ambetter is part of the product organization within PA Health & Wellness, reporting to the Vice President, Products. The product organization is focused on the non-Medicaid parts of the PHW business, dedicated to growing those businesses into state wide offerings.  This leadership role will develop a critical piece of business in Pennsylvania from a 3 county offering to a full state offering.  

Position Purpose:
Manage work flow of the department and maintain production and quality standards for the department.
Ensure compliance with all related laws, regulations and executive orders.
Review and analyze reports, records and directives, and confer with staff to obtain data required for planning work function activities.
Establish the department’s strategic vision, objectives, and attendant policies and procedures for the organization.
Evaluate and implement improved procedures and practices for accomplishing the organization and department’s objectives and to ensure compliance with all related laws, regulations and executive orders.
Coordinate activities of assigned work function and/or department with related activities of other work functions and/or departments to ensure efficiency and proper prioritization.
Analyze reports and records on departmental and organizational activities and disseminate relevant information to business unit leaders for effective decision making.
For PA Health & Wellness - Oversees staff to provide for the timely and accurate processing of Claims, Encounter forms and other information necessary for meeting Agreement requirements and the efficient management of the CHC-MCO.


Coordinate, negotiate and handle activities of the department and aid the chief administrative officer in formulating and administering organization policies and procedures.

Bachelor's degree in Management or Business or equivalent experience.

4+ years experience in management, business, or contracting.

Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.

Managed care, insurance, Medicare or Medicaid experience preferred.

Preferred Qualifications:

Superior knowledge and understanding of Ambetter products or Medicare Advantage products

Highly refined oral and written communication skills

Proven ability to deliver impactful presentations to diverse audiences including executive leaders

Demonstrated ability to develop strong business relationship with internal and external partners to drive business results

Experience leveraging data to drive business decisions and provide solutions to complex business problems

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.

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  • Health Insurance Operations, Pittsburgh, Pennsylvania, United StatesRemove
  • Leadership, Pittsburgh, Pennsylvania, United StatesRemove

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