Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.
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.
Applicants for this job have the flexibility to work remote from home and must reside in Florida.
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.
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.Pay Range: $107,700.00 - $199,300.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
