You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Oversee the operation of the Contract Implementation Analyst and Claims Liaison teams

• Oversee the claims operation function, including contracting and configuration
• Identify and manage risks, resolve conflicts and remove barriers that impede area’s ability to achieve goals and performance expectations
• Provide management to expedite resolution of claims issues and support in policy decisions related to claims operations
• Manage and identify process improvement opportunities in the health plan’s workflow to assure timely, accurate submission and implementation of contracts
• Perform random audits of provider setup within the provider information system to ensure accurate contract implementation and subsequent claims processing
• Act as health plan interface on software product upgrades and implementations that affect contract implementation
• Interface with all organizational levels to mobilize commitment and ensure accurate configuration, contract implementation, and claims operations
• Proactively interact with external stakeholders as it relates to new product implementations
• Serve as the subject matter expert in resolution of claims and configuration issues
• Conduct internal audits of contracts and related files to ensure compliance with corporate standards related to contracts and their implementation

Additional responsibilities for Pennsylvania Health & Wellness:
Manage the day to day responsibilities for the contract implementation and claims resources teams.
Collaborate with the encounters team to ensure encounters are submitted timely and correctly.

Education/Experience: Bachelor’s degree in related field or equivalent experience. 5+ years of provider relations/services, provider contracting and/or claims administration experience in a managed care environment. 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. Experience with Medicare and Medicaid claims and contracting preferred.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.