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Manager, Claims Configuration and Business Analysis

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.

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What does it take?

What are the qualities that will help you achieve success in this role at Centene?

Success Profile

  • Detail-oriented
  • Organized
  • Proactive
  • Positive
  • Trustworthy
  • Consistent

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Our Customer Service Roles

Customer Care Opportunities at Centene

Our Customer Service teams work to ensure high levels of service and customer satisfaction. Learn more about this vital group at Centene

Claims Analyst

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.

Claims Liaisons

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.

Enrollment Analyst

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.

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Responsibilities

Job ID 1174618

Category Leadership
Schedule Full-time
Description:
Position Purpose: Manage and support claims analysis and research. Provide analytical information that identifies process improvement and root cause analysis of issues. Develop and implement solutions to improve overall delivery of claims operations. Ensure claims operation is able to meet or exceed performance measures.  Lead team in conducting various analysis and interpretation to link business needs and objectives for cross-functional business units, aligning and implementing solutions, and develop and deploy process improvements.  As this position is leadership facing and a highly visible role within the organization, strong written and verbal communication skills are necessary.

  • Manage and mentor Claims Business Analysts.
  • Collect, validate and analyze data to deliver business solutions.
  • Monitor performance and develop & implement business solutions to address process and/or quality gaps.
  • Utilize project management skills to work with cross functional teams on delivery of solutions.
  • Promote change through sharing of best practices.
  • Leverage automation to achieve desired results.
  • Interface with and manage all organizational levels to mobilize commitment.
  • Perform claim adjudication project analysis and preparation work flow management.
  • Develop and implement required Process Bulletins.
  • Identify automation opportunities to decrease spend levels.
  • Reduce adjustment volume through root cause analysis and correction.
  • Qualifications:

    Education/Experience: Bachelor's degree in a related field or equivalent experience. 5+ years of experience in health plan operations, preferably with Medicare and/or Medicaid or equivalent business experience. Ability to deal with abstract variables and apply principles of logic or scientific thinking to define problems, collect data, establish facts, and draw valid conclusions. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.


    Additional preferred skills include: management experience with leading, coaching, and training.  Experience in benefits, pricing, contracting or claims, member quality and knowledge of provider reimbursement methodologies.  Product Management, SQL, Amisys, or other claims system.  Managing projects with a high reliance on technology.  Knowledge of data integration, software enhancements/planning and previous structured testing.



    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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    Quote

    “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

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    Our Awards

    Centene is consistently recognized for how well we treat our members, our people, and the communities we serve.

    Honored to be Honored

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    Our Hiring Process

    Learn more about our hiring process and discover other helpful information for applicants.

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    “Centene is an exciting company to work for.”

    Esmeralda Baig

    Started as a Case Manager, now a Senior Vice President of Operation

    See Esmeralda's career path

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