Apply on Employer Site

Centene Corporation · 1 day ago

Senior Manager, Claims Process Initiatives

United States

Full-time

Remote

Mid, Senior Level

$108K/yr - $199K/yr

5+ years exp

Centene Corporation is transforming the health of communities, seeking a Senior Manager for Claims Process Initiatives. This role involves managing strategic projects for the Claims business unit, overseeing governance, compliance, and system integration while providing leadership and expertise in claims operations.

Hospital & Health Care

No H1B

Responsibilities

Lead Claims Process Change Control, including approval of process changes initiated internally or by partner organizations

Provide claims input for business requirements related to system changes, upgrades, and partner initiatives (e.g., Auth, Payment Integrity)

Partner with Information Technology on automation and configuration updates, including oversight of testing and go/no-go decisions

Ensure integration across claims, eligibility, provider, and utilization management systems

Oversee data/reporting integration to support operational and downstream needs

Coordinate claims input for legal actions and build frameworks for legal responses, including Payment Integrity and market communications

Review and approve business solutions and implementation requirements for new business to ensure compliance with health plan, state, and provider contract requirements

Research, define, and manage business specifications for system infrastructures for new market builds and reprocurements

Maintain policies and specifications to accommodate regulatory or business changes

Conduct contract reviews to identify and operationalize new or changing requirements (e.g., SLAs, reporting)

Oversee project plans and track key milestones for claims readiness, including readiness reviews

Provide claims operations expertise for RFPs, RFIs, and audit readiness

Lead process improvement initiatives in collaboration with cross-functional teams

Develop and maintain policies and procedures (P&Ps) ensuring compliance with state/federal regulations, contracts, and SLAs

Performs other duties as assigned

Complies with all policies and standards

Qualification

Claims processing expertiseHealthcare operationsProject managementRegulatory knowledgeCross-functional team leadershipPolicy developmentProcess improvementLegal coordination