Manager, Claims Research – Analysis

Job not on LinkedIn

🔥 15 hours ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $107.7k - $199.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Manage and support claims analysis and research • Provide analytical information identifying process improvement and root cause analysis of issues • Develop and implement solutions to improve overall delivery of claims operations • Ensure claims operations meet or exceed performance measures • Manage and mentor Claims Business Analysts • Collect, validate and analyze data to deliver business solutions • Monitor performance and develop and implement business solutions addressing process and/or quality gaps • Work with cross-functional teams on solution delivery using project management skills • Promote change by sharing best practices • Leverage automation to achieve desired results • Interface with and manage all organizational levels to mobilize commitment • Perform claim adjudication project analysis and preparation workflow management • Develop and implement required Process Bulletins • Identify automation opportunities to decrease spend levels • Reduce adjustment volume through root cause analysis and correction

🎯 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 a related field or equivalent experience • 5+ years of experience in health plan operations, preferably with Medicare and/or Medicaid or equivalent business experience • Ability to deal with abstract variables and apply principles of logic or scientific thinking to define problems, collect data, establish facts, and draw valid conclusions • Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff • Must reside in Florida

🏖️ 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