Claims Supervisor

🔥 22 minutes ago

🐊 Florida, Michigan, +1 more states – Remote

🐊 Florida – Remote 🚗 Michigan – Remote 🏰 Missouri – Remote

💵 $56.2k - $101k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

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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 complying with state and federal regulations • Improve processes and control costs to process medical claims accurately and timely • Serve as liaison between internal customers, vendors and other stakeholders involved in the claims life cycle • Ensure Claims inventory is managed accurately, timely and within compliance requirements • Prioritize daily work volumes through reporting, load balancing, and operational overtime cost management • Identify improvement opportunities and resolve operational gaps/problems • Assist in reviewing, investigating, adjusting, and resolving pending claims, especially complex claims • Serve as escalation point for complex claims matters • Monitor claims quality reviews, document results, and identify trends and systemic root causes • Research, collect background information and documentation, and address issues for the team, plan, and other departments • Prepare reporting, analysis, and insights to drive operational excellence • Maintain appropriate records, files, and documentation • Perform special projects and other assigned duties • Facilitate change to support current and future business needs

🎯 Requirements

• Associate degree in related field or equivalent experience required • 2+ years of health insurance industry, claims processing, physician’s office or other office services experience required • Previous experience in a supervisory/lead role with defined outcomes required • Experience with Medicaid, Marketplace and/or Medicare preferred • Must comply with all policies and standards • Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

🏖️ Benefits

• Competitive pay • Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity