Senior Manager, Business & Systems Operations

🔥 12 hours ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $107.7k - $199.3k / year

⏰ Full Time

🟠 Senior

⚙️ Business Operations

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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

• Identify, manage and oversee system and business requirements for new and existing business • Ensure performance meets health plan, state and provider contract requirements • Oversee system builds for new markets and products, including configuration and testing • Monitor and evaluate system performance trends and identify improvement opportunities • Oversee the timeliness and accuracy of reporting deliverables • Establish and manage business specifications for authorization and claims/encounters system infrastructure • Identify and implement process improvements across new business implementations, claims, encounters, auto adjudication, benefit specification testing and system integrity • Establish and manage special projects to improve organizational efficiency, productivity and accuracy • Oversee design and maintenance of market provider contract rate exhibits and configuration/testing of negotiated contracts

🎯 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 related field or equivalent experience • 6+ years of health care operations, system administration, product/program management or claims administration experience • Experience with Medicaid and Medicare coding • Experience with benefit design • Experience with reimbursement strategies/methodologies • Previous management experience, including hiring, training, assigning work and managing staff performance • Contracting and provider data management experience preferred • Master's degree preferred

🏖️ 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 • Additional forms of incentives may be included in total compensation • Equal opportunity and diversity commitment