Director, Claims Configuration

Job not on LinkedIn

🔥 13 hours ago

🚗 Michigan – Remote

🚗 Michigan – Remote

💵 $141.5k - $261.4k / year

⏰ Full Time

🔴 Lead

👔 Director

👻 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 claims configuration and pricing/benefits setup within the claims payment system • Ensure accurate reflection of provider contracts and claims payments • Ensure timely and accurate configurations and pricing/benefits setup for new business implementations • Ensure changes in provider contracts are reflected in the claims payment system • Collaborate with stakeholders to gather business requirements for system configurations and setup • Identify and implement opportunities to automate processes • Oversee evaluation and analysis of upcoming implementations • Ensure successful and smooth transition into claims systems and processes

🎯 Requirements

• Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future • Bachelor's degree in Business Administration, Health Care Administration, Information Technology or related field, or equivalent experience • 7+ years of configuration, claims adjudication, pricing/benefits setup, or contracting experience

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • Stock purchase plan • 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