Manager, Claims Research & Analysis

You could be the one who changes everything for our 28 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.

• Applicants for this job have the flexibility to work remote from home anywhere in the United States

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.

• Utilize project management skills to work with cross functional teams on delivery of solutions.
• Collect, validate and analyze data to deliver business solutions.
• Develop and implement required Process Bulletins.
• Promote change through sharing of best practices.
• Reduce adjustment volume through root cause analysis and correction.
• Leverage automation to achieve desired results.
• Perform claim adjudication project analysis and preparation work flow management.
• Manage and mentor Claims Business Analysts.
• Monitor performance and develop & implement business solutions to address process and/or quality gaps.
• Identify automation opportunities to decrease spend levels.
• Interface with and manage all organizational levels to mobilize commitment.

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.

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.