You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Oversee all related activities and staff for the Claims Operations. Collaborate with Provider Services and Provider Relations to identify and resolve claims issues and assist internal departments with claims submission policies and procedures to insure prompt and accurate claims adjudication.

• Provide technical support and expertise to staff for claims and contract resolution and project submission
• Ensure smooth work transitions between various department functions and responsibilities
• Identify, review, test and implement new processes within the department to enhance productivity and quality
• Oversee and monitor daily activities and work distribution
• Review and report on team’s performance and training needs or performance improvements
• Serve as a liaison between the plan departments, Corporate claims departments, various internal departments, and outside vendors for all claims and contracting activities
• Provide Health Plan management with all necessary data to allow for expedient resolution of claims issues & support Health Plan management at all times
• Provide pricing instructions on claims appeals, adjustments, and pends
• Educate internal departments on provider billing guidelines and procedures, including developing and maintaining training materials
• Ensure timely and accurate submission of contracts, contract implementation/configuration and subsequent claims processing through provider setup, UAT testing, etc
• Ensure state changes in reimbursement and/or benefits and request appropriate changes to configuration to correctly & timely implement these changes

Education/Experience: Bachelor’s degree or equivalent experience. 3+ years of claims processing or provider contract experience in a managed care environment. Previous experience as a lead in a functional area or managing cross functional teams on large scale projects.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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.