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Centene Corporation · 2 days ago

Manager, Claims Quality Review

United States

Full-time

Remote

Mid, Senior Level

$88K/yr - $158K/yr

4+ years exp

Centene Corporation is transforming the health of communities and is seeking a Manager for Claims Quality Review. This role involves managing the review of high-risk claims to ensure payment integrity, providing feedback, and collaborating with stakeholders to enhance quality in claims processing.

Hospital & Health Care

No H1B

Responsibilities

Manage the Claims Quality Analysts to perform quality review of completed high risk claims and provide immediate feedback to partners including coaching for Quality Review, Internal Audits and High Dollar Review

Perform focus reviews of claims processed to identify root cause of errors and provide management with possible solutions including high dollar claims

Build relationships and collaborate with key stakeholders to ensure timely completion of project tasks

Provide written documentation to Claims Operations management regarding results; provide assistance to claims staff on quality issues in an effort to increase quality

Serve as an account management contact for assigned health plans and/or specialty companies; serve as advocate to proactively address, respond to and facilitate identified customer needs and escalated issues and inquiries

Track claims quality trends and review Internal Audit claims quality results (with a focus centered on manual errors); coordinate root cause analysis and identify corrective actions to improve results

Qualification

Claims processing experienceQuality review managementRoot cause analysisHealthcare AdministrationBusiness AdministrationManagement Information SystemsCoaching skillsStakeholder collaborationCross functional team managementWritten documentation

Required

Bachelor's degree in Healthcare Administration, Business Administration, Management Information Systems, related field, or equivalent experience

4+ years of related Health insurance or claims processing experience

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

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future