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Senior Director, Claims Transformation

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 1187790

Category Claims Operations
Schedule Full-time
Description:

Position Purpose: Direct and oversee the end to end claims process and performance assurance programs across the operations. Direct the day-to-day operations of the Claims Department to ensure accurate and timely processing of members medical claims within established state and company compliance guidelines. This role will drive quality, compliance, and efficiency to ensure optimized metrics within the operations organization.

Position Responsibilities:

  • Lead the organization in the development of effective and efficient business processes that will meet or exceed internal and external performance expectations

  • Develop strategic vision and execution roadmap for quality and process improvement initiatives that establish a culture of quality by participating in long-range planning

  • Serve as the primary leader and expert regarding the end-to-end claims process

  • Partner with multiple stakeholders business unit and health plan leadership to establish operational objectives and procedures

  • Lead the organization in the development of effective and efficient business processes

  • Oversee implementation of operational efficiencies and development of “best practice” policies and procedures

  • Provide strategic direction and leadership in developing innovative initiatives to improve overall quality outcomes

  • Monitor and analyze costs, prepare annual budget and operate department with the budget

  • Establish consolidated and consistent processes and relationships with internal and external partners to support the business in achieving its strategic and tactical objectives

  • Achieve and maintain all processing and expense standards relating to the Claim Operations

  • Collaborate with various cross-functional leaders to identify and execute process improvements and effective initiatives including the proposal and implementation of new technological tools.

  • Oversee all compliance standards for claims, ensuring operations are actively managing and reducing operational risk and introducing programs and initiatives to promote positive outcomes.

  • Oversee change management, and communication and dissemination of critical information to stakeholders, partners, leaders and peers both upstream and downstream

  • Assess progress and report statuses to upper management and key stakeholders including timelines and milestones

  • Analyze customer impact and respond to complex escalated customer service issues to ensure the customer expectations are consistently exceeded

Qualifications:


Education/Experience: Bachelor’s degree or equivalent experience. Masters Degree preferred. 8+ years of claims operations, project management, process improvement or shared services experience, preferably in a managed care and/or Medicaid setting. Strong process improvement experience with a keen focus on quality.  Previous experience with organizational and strategic business process design and development experience preferred. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff preferred.

Preferred License/Certification:
Six Sigma Black Belt, Certified Quality Manager, or other advanced quality certification 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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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.

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Our Hiring Process

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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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