Company
Centene Corporation
Description
Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 26 million members.
Position Purpose Lead and manage a large scale organization accountable for the accurate, timely and efficient processing of Member and Provider Appeals and Grievances. Direct day to day operations of the claims departments and ensure the claims are processed within established government and company guidelines. Drive the organizational strategy to achieve Medicare STARS performance expectations and create system of control across workflows and compliance requirements.
Set the strategic Medicare appeals vision in compliance with federal, state and Company guidelines
Oversee Appeals Operations and ensure quality and service level agreements are met
Collaborate with leadership from internal departments to ensure efficiency and proper prioritization of the appeals process
Develop, maintain, and ensure production and quality standards are met and audit outcomes are achieved.
Ensure service levels are met and increase real time prioritization and productivity capabilities
Establish, evaluate, and implement policies, processes, and procedures to accomplish the organizations and departments’ objectives
Ensure compliance with all state and federal appeals and grievance laws and guidelines
Build the Operating Model and talent pipeline to scale across the enterprise.
Provide strategic and budget leadership in annual operating plans.
Education/Experience Bachelor’s degree in Business Administration, Management, or Finance; Master’s degree preferred. 10 years of experience in overseeing and developing claims/appeals operations, preferably in a managed care and/or Medicare setting. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff
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.
Position Purpose Lead and manage a large scale organization accountable for the accurate, timely and efficient processing of Member and Provider Appeals and Grievances. Direct day to day operations of the claims departments and ensure the claims are processed within established government and company guidelines. Drive the organizational strategy to achieve Medicare STARS performance expectations and create system of control across workflows and compliance requirements.
Set the strategic Medicare appeals vision in compliance with federal, state and Company guidelines
Oversee Appeals Operations and ensure quality and service level agreements are met
Collaborate with leadership from internal departments to ensure efficiency and proper prioritization of the appeals process
Develop, maintain, and ensure production and quality standards are met and audit outcomes are achieved.
Ensure service levels are met and increase real time prioritization and productivity capabilities
Establish, evaluate, and implement policies, processes, and procedures to accomplish the organizations and departments’ objectives
Ensure compliance with all state and federal appeals and grievance laws and guidelines
Build the Operating Model and talent pipeline to scale across the enterprise.
Provide strategic and budget leadership in annual operating plans.
Education/Experience Bachelor’s degree in Business Administration, Management, or Finance; Master’s degree preferred. 10 years of experience in overseeing and developing claims/appeals operations, preferably in a managed care and/or Medicare setting. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff
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.
Identifier
17aa158f0d9ff493fbf748acd73d150e
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Ready to join the team? We'd love to have you!