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Centene Corporation Director, Claims Operations in Great Falls, Montana

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose:

Direct the day-to-day operations of the claims department and ensure accurate and timely processing of members medical claims within established state and company compliance guidelines. A key area of focus for this leader will be eliminating causes of rework and improving first pass quality and automation.

  • Develop the vision and goals for the claims department in compliance with federal, state and Company guidelines

  • Develop multi-year planning and pipeline of initiatives that support growth at scale, applying current and emerging technologies to business challenges to develop new solutions and reimagined processes to address customer pain points

  • Ability to make significant improvements and transform the organization into predictive first pass quality and automation claims service team and eliminate the rework / non-value added activities

  • Employs data analytics, root cause analysis, and other techniques to drive a full understanding of the business improvement opportunities

  • Effectively communicate key objectives, measures, and progress to all stakeholders and executive leadership

  • Manage a portfolio of savings and provider / member experience initiatives

  • Oversee and ensure achievement and maintenance of all claims processing standards within established guidelines

  • Partner with multiple business units, health plans and other stakeholders to establish operational objectives and procedures.

  • Identify business needs and drive change initiatives to address these issues

  • Ensure all issues are resolved accurately and timely and implement action plans to address any issues

  • Identify and implement operational efficiencies and development of “best practice” policies and procedures

  • Analyze customer impact and respond to complex escalated customer service and claims processing issues to ensure that customer expectations are consistently met

Our Comprehensive Benefits Package:

  • Flexible work solutions including remote options, hybrid work schedules and dress flexibility

  • Competitive pay

  • Paid Time Off including paid holidays

  • Health insurance coverage for you and dependents

  • 401(k) and stock purchase plans

  • Tuition reimbursement and best-in-class training and development

Education/Experience:

Bachelor’s degree or equivalent experience. 7+ years of operations management, financial management or analysis, or claims operations experience, preferably in a managed care and/or Medicaid setting. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. Leadership experience with delivering high value improvements (for instance $1M plus savings) using Lean / Six Sigma preferred. Experience implementing cross-department improvement initiatives preferred.

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.

TITLE: Director, Claims Operations

LOCATION: Great Falls, Montana

REQNUMBER: 1249606

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