Director, Claims Operations
Centene Corporation Tyler, Texas
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 Claims Operations
Develop the vision and goals for the claims department in compliance with federal, state and Company guidelines
Oversee and ensure achievement and maintenance of all claims processing standards within established guidelines
Partner with multiple business units, health plans and other stakeholders to establish operational objectives and procedures.
Identify business needs and drive change initiatives to address these issues
Ensure all issues are resolved accurately and timely and implement action plans to address any issues
Identify and implement operational efficiencies and development of “best practice” policies and procedures
Analyze customer impact and respond to complex escalated customer service and claims processing issues to ensure that customer expectations are consistently met
Direct the day-to-day operations of the claims department and ensure accurate and timely processing of members medical claims within established state and company compliance guidelines.
Bachelor’s degree or equivalent experience. 7+ years of operations management, financial management or analysis, or claims operations experience, preferably in a managed care and/or Medicaid setting. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
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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