Vice President, Claims Configuration Operations

Centene is transforming the health of our communities one person at a time.  As an Executive on our team, you could be the one who changes everything for our 28 million members.  

Position Purpose: Lead and manage a large scale organization accountable for the accurate, timely and efficient processing of Medical and Behavioral claims. Direct day to day operations of the claims departments and ensure the claims are processed within established government and company guidelines.

• Set the strategic claims vision in compliance with federal, state and Company guidelines.

• Oversee the claims department and ensure quality claims metrics and service level agreements are met.

• Collaborate with leadership from internal departments to ensure efficiency and proper prioritization of the claims adjudication process.

• Develop, maintain, and ensure production and quality standards are met and audit outcomes.

• Ensure service levels and increase real time prioritization and productivity capabilities.

• Establish, evaluate, and implement processes and procedures to accomplish the organization's and departments’ objectives.

• Ensure compliance with all state and federal claims payment laws and guidelines.

Education/Experience:

• Bachelor's Degree in Business Administration, Management, or Finance required.

• Master's Degree preferred.

• 10+ years of experience in overseeing and developing claims operations, preferably in a managed care and/or Medicaid setting required.

• Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff required.

• DE Only: A full-time Claims Director who will interact at the executive level and is responsible for all claims management activities, including claims processing, payment of claims, Third Party Liability, and Encounter Data reporting.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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