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Centene Corporation · 1 day ago

Supervisor, Claims

United States

Full-time

Remote

Mid, Senior Level

$56K/yr - $101K/yr

2+ years exp

Centene Corporation is transforming the health of our communities, one person at a time. The Supervisor will oversee the day-to-day work functions of the assigned claims area, providing technical and leadership support to staff while ensuring compliance with regulations and improving process efficiency.

Hospital & Health Care

Responsibilities

Oversee the 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

Process improvement, cost control to process medical claims accurately and timely and serve as a liaison between internal customers, vendors and other stakeholders involved in the claims life cycle

Provide oversight and support to ensure that Claims inventory is managed accurately, timely and within compliance - internal and regulatory requirements

Prioritize work volumes daily through reporting, load balancing, and managing operational overtime cost

Help to identify opportunities for improvements and resolve operational gaps/problems with a financial, regulatory, cost/benefit and stakeholder experience

Assist in reviewing, investigating, adjusting, and resolving all pending claims, especially complex claims. Serve as a point of escalation for these matters

Monitor claims quality reviews for accuracy, document results and identify trends and systemic root cause analysis

Point of contact for the team, for the plan and for other departments in researching, collecting background information and documentation and to address various issues

Responsible for preparing reporting, analysis and insights that is consistent with defined standards to drive operational excellence. Maintain appropriate records, files, documentation, etc

Special Project work as assigned

Facilitate change to support current and future business needs

Performs other duties as assigned

Complies with all policies and standards

Qualification

Claims processingSupervisory experienceHealth insurance industryMedicaid experienceMedicare experienceProcess improvementCost controlAnalytical skillsCommunication skills