Claims Supervisor

🔥 0 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $56.2k - $101k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Oversee the day-to-day work functions of the assigned claims area • Provide technical and leadership support to staff to resolve complex issues • Develop and implement policies and procedures compliant with state and federal regulations • Improve processes and control costs to process medical claims accurately and timely • Serve as a liaison between internal customers, vendors, and other claims-life-cycle stakeholders • Ensure claims inventory is managed accurately, timely, and in compliance with internal and regulatory requirements • Prioritize daily work volumes through reporting, load balancing, and operational overtime management • Identify improvement opportunities and resolve operational gaps and problems • Review, investigate, adjust, and resolve pending claims, especially complex claims • Serve as an escalation point for claims matters • Monitor claims quality reviews, document results, and identify trends and systemic root causes • Research issues, collect background information and documentation, and address issues for the team, plan, and other departments • Prepare reporting, analysis, and insights according to defined standards to drive operational excellence • Maintain appropriate records, files, and documentation • Perform assigned special projects • Facilitate change to support current and future business needs • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Associate degree in a related field or equivalent experience required • 2+ years of experience in the health insurance industry, claims processing, a physician’s office, or other office services required • Previous experience in a supervisory or lead role with defined outcomes required • Experience with Medicaid, Marketplace, and/or Medicare preferred • Must be authorized to work in the U.S. without employment-based visa sponsorship now or in the future • Sponsorship is unavailable for employment-based visa types including H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules