Director, Claims Business Implementation

Job not on LinkedIn

🔥 0 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $148k - $274.2k / year

⏰ Full Time

🔴 Lead

👔 Director

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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 implementation of products and plans into Claims business units • Ensure alignment with strategies and goals and consistency in implementation processes, methodology, and models • Direct creation and maintenance of standard models for the claims implementation approach • Manage all Claims and Configuration Operations functions during the implementation phase • Provide strategic leadership and oversight of claims business implementation processes • Manage adherence to standard implementation processes and collaborate on Business Requirements Document approvals with the Claims Process Owner • Provide input into operating models, corporate functional and information system models, performance metrics, expected outcomes, and plan impacts • Direct claims business implementations to meet budget, timeline, and scope requirements • Provide input into business planning and develop timelines for New Health Plan Business Implementations

🎯 Requirements

• Bachelor's degree in related field or equivalent experience • Master's degree preferred • 7+ years of project management experience • Detailed understanding and experience applying project management methodologies and tools • 5+ years of Government Programs Managed Care experience in multiple areas of Operations, including Claims, Provider/Mbr Services, Medical Management, or Network • Medicaid Managed Care experience preferred

🏖️ Benefits

• 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 • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity