Director, Executive Grievances and Appeals
Centene Corporation St Louis, Missouri
As part of the Customer Service department, you’ll use your knowledge of Centene’s insurance products and service to help our members understand their benefits, details and policy procedures. With your skills, you can help transform the health of every community, one person at a time.
What does it take?
What are the qualities that will help you achieve success in this role at Centene?
“I enjoy knowing that by doing my job efficiently, our providers can focus on giving the best care to the members we serve.”- Kim Joyce, Claims Analyst
“Centene has been instrumental in my professional development. I’m pushed in a way that challenges my fears, improve my skills, and enhance my knowledge on healthcare.”- Meaghan Hooks, Business Analyst II
“My job has a direct impact on our providers and members. With every claim paid out the door we are directly helping to save someone’s life!”- Jonelle Levy, Business Analyst II
Category Customer Service
Develop and implement programs centered on quality and operations excellence
Develop and monitor service levels to ensure compliance with state, federal, and company metrics and standards
Initiate ongoing and special projects including process improvement evaluations and analysis, department business development, ROI analysis, and annual satisfaction initiatives
Direct all membership related initiatives including identification of business need, strategy recommendation, project outline, management of deliverables, and ROI
Work collaboratively to facilitate the design, development and implementation of policies, procedures and practices related to service operations
Establish and maintain working relationships with external sources such as CMS for regulatory and compliance guidance
Develop and maintain collaborative relationships with health plans, other business units, IT partners, and oversee training and business processes as necessary
Responsible for the development, implementation and management of business operations such as billing and enrollment, call center, customer service, etc. and related initiatives that impact membership for product lines and health plans. Manage service levels; identify service opportunities, new business implementations and product expansions
Bachelor’s degree in Business or related field or equivalent experience. 7+ years of business operations (call center, enrollment, billing, payment processing, or similar operations) experience preferably in a managed care and/or Medicare environment. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. Health insurance and project management experience 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.
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Our Customer Service Roles
As part of a tight-knit team and working as a partner to each provider, you’ll evaluate the needs of your health plan and process all claims in accordance with guidelines.
While ensuring that provider and member requests are taken care of, you’ll review requests from providers and work with state health plans to ensure the accuracy and quality of claims.
Customer Service Representative
You’ll use your healthcare knowledge, analytical skills and our information resources to quickly and correctly answer questions from members and providers.
You’ll process incoming membership files and focus on maintaining the enrollment integrity of our individual health plan systems.
Systems Solutions Manager
While leading a team of business analysts, you’ll work with the IT department to drive end-to-end solutions for core applications supporting Centene’s operations. Claims Analyst.
Centene is consistently recognized for how well we treat our members, our people, and the communities we serve.Honored to be Honored
Our Hiring Process
Learn more about our hiring process and discover other helpful information for applicants.Learn More
“Centene is an exciting company to work for.”
Started as a Case Manager, now a Senior Vice President of OperationSee Esmeralda's career path
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