Supervisor, Financial & System Integrity

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose:  Manage all activities and personnel within the Superior Health Plan Claims Operational Auditing Department for Market Place. Work closely with internal departments to identify claims issues, ensuring that claims reimbursement policies and state procedures are both timely and accurate.

 In this Supervisor, Financial & System Integrity role, you will:

• Research claims and validate correct reimbursement and processing guidelines
• Research claims, identify root cause and work with other departments to find remediation
• Collaborate between multiple departments to ensure smooth transition of work to resolve or prevent claims issues
• Provide support and claims and processes expertise to staff to ensure work is completed on time and quality is met
• Monitor, identify trends and escalate issues to prevent member, provider abrasion to include preventing compliance and or penalties.
• Manage workflow and monitor daily activities by organizing and prioritizing task to ensure completion is timely
• Identify, review, and implement new processes within the department to enhance productivity and quality
• Monitor and track performance by evaluating, providing feedback to improve quality
• Support development by identifying training gaps and development needs to improve growth

Education/Experience:

• Bachelor's degree or equivalent experience.
• 3+ years of claims processing or provider contract experience in a managed care environment.
• Previous experience as a lead in a functional area or managing cross functional teams on large scale projects.

Preferred Skills:

• Possess knowledge of claims payment and state reimbursement guidelines for Market Place
• Experience supporting a large team in a supervisory/leadership role
• Intermediate Excel

*Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States.  Due to the needs of the business, ideal schedule starts at 7:00am Central Standard Time.*

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.  Total compensation may also include additional forms of incentives.

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