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About the Role

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.

Responsibilities

• Oversee day-to-day work functions of the assigned claims area.
• Provide technical and leadership support to staff to resolve complex issues.
• Develop and implement policies and procedures that comply with state and federal regulations.
• Drive process improvement and cost control to process medical claims accurately and timely.
• Serve as a liaison between internal customers, vendors, and stakeholders in the claims lifecycle.
• Provide oversight and support to ensure claims inventory is managed accurately, timely, and within compliance.
• Prioritize work volumes daily through reporting, load balancing, and managing operational overtime costs.
• Identify opportunities for improvements and resolve operational gaps/problems.
• Assist in reviewing, investigating, adjusting, and resolving all pending claims, especially complex claims.
• Serve as a point of escalation for complex claims matters.
• Monitor claims quality reviews for accuracy, document results, and identify trends and systemic root cause analysis.
• Act as a point of contact for the team, the plan, and other departments.
• Prepare reporting, analysis, and insights to drive operational excellence.
• Maintain appropriate records, files, and documentation.
• Perform special project work as assigned.
• Facilitate change to support current and future business needs.
• Perform other duties as assigned.
• Comply with all policies and standards.

Requirements

• 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.
• Associate degree in a related field or equivalent experience required.
• 2+ years of health insurance industry, claims processing, physician’s office, or other office services experience required.
• Previous experience in a supervisory/lead role with defined outcomes required.
• Must have successfully completed Centene's additional progressive claims training programs and ramp period.

Skills

• Claims processing
• Leadership
• Process improvement
• Cost control
• Reporting
• Analysis
• Medicaid
• Medicare
• Marketplace

Location

• Remote
• Hybrid
• Field
• Office

Work Type

• Remote
• Hybrid
• Field
• Office

Experience Level

• Supervisor/Lead role experience

Education Level

• Associate degree or equivalent experience

Salary/Compensations

• $27.02 - $48.55 per hour

Benefits

• Competitive pay
• Health insurance
• 401K
• Stock purchase plans
• Tuition reimbursement
• Paid time off
• Holidays
• Flexible approach to work

About the Company

• 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.

Equal Opportunity

• 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.
• Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.