Senior Manager, Claims Quality Improvement

Job not on LinkedIn

🔥 0 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $107.7k - $199.3k / year

⏰ Full Time

🟠 Senior

👔 Manager

👻 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

• Lead high-impact quality initiatives across a complex claims operation • Provide leadership and direction for continuous quality improvement initiatives • Analyze reports to identify trends and opportunities and recommend improvement initiatives • Identify risks and drive improvements in claims quality, payment accuracy, audits, controls, and business outcomes • Lead large-scale quality initiatives and operational excellence efforts • Oversee the NCQA accreditation process and compliance with contractual requirements • Coordinate company-wide quality assessment and improvement activities • Coordinate annual file audits and other corporate and contractual quality initiatives • Implement work tools, processes, reports, and audit tools to control key processes and program characteristics • Recommend quality improvement opportunities and develop and implement solutions with management, the Quality Improvement Committee, and other committees • Provide feedback to rectify errors and prevent further inconsistencies • Oversee monthly and quarterly reports and data to identify trends, improvement opportunities, and interventions • Maintain policies and operating procedures and align goals with internal and external guidelines

🎯 Requirements

• Bachelor’s degree in Business, Healthcare, or related field • Master's degree preferred • 5+ years of quality management experience or equivalent leadership experience • Previous experience as lead in a functional area • Experience managing cross-functional teams on large-scale projects or supervisory experience • Supervisory experience including hiring, training, assigning work, and managing staff performance • Deep expertise in claims operations, payment accuracy, audit methodologies, quality management systems, regulatory requirements, and operational controls • Strong analytical and problem-solving skills • Experience with data analysis, root cause analysis, statistical methods, and Lean/Six Sigma principles • Understanding of business systems, automation, reporting tools, and emerging AI capabilities • Knowledge of NCQA accreditation and contractual compliance requirements

🏖️ 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 employer committed to diversity