Centene Corporation

Operations

• Lead and mature the cloud cost optimization initiatives
• Serve as a subject matter expert, partnering with engineering, finance, and procurement teams
• Proactively identify opportunities and influence strategic decisions
• Build and maintain financial models to forecast cloud spend
• Create executive-level reporting that connects cloud economics to business outcomes

Cloud FinOps Analyst II

Actuary

• Assist in financial analysis and forecasting, pricing, and risk assessment to estimate outcomes
• Support actuarial forecasting and financial analysis for ACA Marketplace individual and family health insurance products
• Analyze and evaluate required premium rates and support estimation of financial outcomes for individual health insurance products
• Develop and run data reports, including independently pulling, preparing, and analyzing large claims and membership datasets to support forecasting, reporting, and actuarial analyses
• Create financial and analytical exhibits and communicate the results to both technical and non-technical audiences
• Assess cash reserves and liabilities to enable payment of future benefits
• Support process improvement and automation efforts to improve scalability, consistency, and timeliness of actuarial analyses

Senior Actuarial Analyst

• Lead and manage a large scale organization accountable for the accurate, timely and efficient processing of Medical and Behavioral claims
• Direct day to day operations of the claims departments and ensure the claims are processed within established government and company guidelines
• Set the strategic claims vision in compliance with federal, state and Company guidelines
• Oversee the claims department and ensure quality claims metrics and service level agreements are met
• Collaborate with leadership from internal departments to ensure efficiency and proper prioritization of the claims adjudication process
• Develop, maintain, and ensure production and quality standards are met and audit outcomes
• Ensure service levels and increase real time prioritization and productivity capabilities
• Establish, evaluate, and implement processes and procedures to accomplish the organization's and departments’ objectives
• Ensure compliance with all state and federal claims payment laws and guidelines

Vice President, Claims Configuration Operations

Medical Director

• Assist the Chief Medical Officer to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.
• Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities.
• Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making.
• Supports effective implementation of performance improvement initiatives for capitated providers.
• Assists Chief Medical Officer in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members.
• Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements.
• Assists the Chief Medical Officer in the functioning of the physician committees including committee structure, processes, and membership.
• Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes.
• Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.
• Participates in provider network development and new market expansion as appropriate.
• Assists in the development and implementation of physician education with respect to clinical issues and policies.
• Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
• Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.
• Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality.
• Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment.
• Develops alliances with the provider community through the development and implementation of the medical management programs.
• As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues.
• Represents the business unit at appropriate state committees and other ad hoc committees.
• May be required to work weekends and holidays in support of business operations, as needed.

Medical Director – Part-Time

Manager

• Assists in developing, assessing, and coordinating holistic care management activities
• May develop or assist with developing personalized service care plans/service plans for long-term care members
• Evaluates the needs of the member, the resources available, and recommends and/or facilitates the plan for the best outcome
• Assists with developing ongoing long-term care plans/service plans
• Coordinates as appropriate between the member and/or family/caregivers and the care provider team
• Provides resource support to members and their families/caregivers for various needs
• Monitors care plans/service plans, member status and outcomes
• Interacts with long-term care healthcare providers and partners
• Collects, documents, and maintains long-term care member information and care management activities
• May perform home and/or other site visits to assess member’s needs
• Provides and/or facilitates education to long-term care members and their families/caregivers

LVN, LTSS Service Care Manager

Product Manager

• Responsible for guiding the strategic direction for a portfolio of technologies within the highest-level Domain space.
• Responsible for the product strategy, roadmap, opportunity identification, business case development, industry research, and new product or feature introduction across the Domain space.
• Responsible for end-to-end product governance from concept to production.
• Aligning and engaging senior stakeholders to manage and measure the delivery of product strategy and roadmap against established goals.
• Own and influence the long-term strategy of complex domain areas and cross-domain products.
• Own and influence the long-term roadmap of a key domain spaces and influence the introduction and shaping of modern technologies and solutions within the space.
• Collaborate with senior leadership and technology teams to negotiate and agree on proposed new systems and changes to existing systems and practices.

Lead Enterprise Platforms Product Manager

Bookkeeper

• Accurately posting and applying daily cash receipts including checks, ACH, wires, and credit card payments against invoices
• Perform daily reconciliation of cash applications
• Research and resolve payment discrepancies and unapplied payments
• Maintain member bank account information for EFT withdrawals
• Reconcile daily cash receipts against treasury cash reports and bank deposits through system uploads and downloads
• Address and resolve member payment inquiries in a timely manner

Accounting Assistant – Cash Applications

Director

• leads strategic business transformation programs with enterprise impact
• acts as a trusted advisor and strategic partner to Centene leadership
• assists with the business transformation team's strategy, execution/delivery methodology, and realizing business benefits across the enterprise portfolio
• manages a team responsible for adhering to the department's Business Transformation Methodology
• provides forward-thinking leadership to a team of Business Transformation Professionals in guiding the business to achieve operational efficiency
• leverages superior knowledge of healthcare, WellCare, business improvement/transformation, organization change management, customer experience, and strategy, to develop training and enforcement of the eBT methodology tools and techniques
• provides guidance, leadership and support to Senior Management in identifying opportunities, providing solutioning, and collaborating to develop strategy
• leads execution of an Enterprise Prioritization Assessment where applicable
• demonstrates thought leadership through out of the box thinking and leveraging deep WellCare knowledge of business processes and systems
• manages a diverse business transformation portfolio affecting organization design, process execution, technology landscape, and business strategy
• leads service offering definition and ensure consistent and superior quality product delivery
• oversees proposed business valuation maximizes impact with an emphasis on hard dollar Return on Investment (ROI) savings or cost avoidance scenarios
• sets overall goals, performance standards, and priorities for one or more functions and manages resources to goals and budget
• sets direction, allocates, and reallocates utilization of resources as required across multiple departments

Senior Director, Business Transformation

• Ensures complaints and issues team document customer complaints and issues based on regulatory and other contractual legal requirements
• Reviews complex inquiry documentation to ensure adherence to quality and regulatory standards
• Manages the team responsible for customer complaints and issues resolution teams by planning, directing, and evaluating team performance
• Collaborates with other departments to ensure customer satisfaction
• Manages identified trends in customer complaints and issues
• Provides guidance to team members on complex customer complaints and issues
• Maintains knowledge of all policies, procedures, and regulations to ensure compliance requirements are achieved
• Escalates issues to senior leadership, including potential regulatory issues
• Promotes and drives collaboration and feedback loop between departments
• Partners with senior leadership to provide performance reviews and oversees training implementation
• Assists in onboarding, hiring, and training new employees within the customer complaints and issues department

Manager, Complaints and Issues – Claim CTMs

Data Analyst

• Leads the integration, conforming, profiling and mapping of complex data
• Leads quality assurance oversight (data error detection and correction)
• Reviews more complex data to optimize the efficiency and quality of the data being collected
• Identifies and resolves complex data quality problems
• Collaborates with the business and ETL database developers to improve systems and database designs
• Leads the work to interpret and analyze complex data from multiple sources including claims, provider, member, and encounters data
• Proactively identifies and assesses the business impact of trends
• Leads the development, execution, maintenance, and troubleshooting of complex scripts and reports developed using SQL, Microsoft Excel, or other analytics tools
• Oversees the root-cause analysis of data irregularities and implements approved solutions
• Leads multiple complex and variable tasks and data review processes with no supervision within targeted timelines
• Provides leadership in a demanding, quickly changing environment
• Leads the delivery of business solution architecture and implementation validation
• Leads the efforts of data profiling and source to target mapping
• Applies advanced expertise in quantitative analysis, data mining, and the presentation of data to see beyond the numbers
• Supports multiple functions and levels of the organization
• Effectively communicates findings and insights to non-technical business partners
• Engages with customers and business partners to gather requirements and validate results
• Presents data-driven insights and recommendations to both internal and external stakeholders
• Performs other duties as assigned
• Complies with all policies and standards

Lead IT Data Analyst

Customer Support

• Serves as the first-line advocate that focuses on resolving inquiries, issues, or concerns for members and/or providers
• Leverages a variety of communication channels to provide members and/or providers with timely, accurate, and personalized support on routine complaints
• Receives and responds to routine member and/or provider inquiries, requests and/or concerns in an accurate and timely manner
• Mitigates and prevents complaints from being escalated to resolve in initial contact
• Maintains performance and quality standards based on established contact center metrics
• Provides customer service in a high pace contact center environment over the phone, via live chats and emails
• Documents all member or provider information and communications for quality and performance tracking through the Customer Relationship Management (CRM) applications

Bilingual Customer Service Advocate, Russian

Account Manager

• Managing the clinical aspects for 2-3 health plans including but not limited to Formular Management
• Providing Clinical Reports
• Communicating with health plan assigned pharmacy teams daily
• Conducting weekly operational calls with the markets to align on open items and projects
• Interface with internal and external teams including state regulators in order to complete contractual obligations for the assigned plans
• Provide clinical expertise to clients in designing benefits/clinical programs to optimize therapeutic outcomes while maintaining economic efficiency in the delivery of medication therapy.

Clinical Account Manager, Pharmacist

• Serves as the first-line advocate that focuses on resolving inquiries, issues, or concerns for members and/or providers.
• Leverages a variety of communication channels to provide members and/or providers with timely, accurate, and personalized support on routine complaints.
• Receives and responds to routine member and/or provider inquiries, requests and/or concerns in an accurate and timely manner.
• Mitigates and prevents complaints from being escalated to resolve in initial contact.
• Serves as the front-line resolution advocate on various member and/or provider inquiries, requests, or concerns.
• Resolves basic problems by communicating the requested information regarding the assessment of the member or provider needs, understanding the cause, and determining if problems need to be routed to other departments for further resolution.
• Maintains performance and quality standards based on established contact center metrics.
• Provides customer service in a high pace contact center environment over the phone, via live chats and emails.
• Documents all member or provider information and communications for quality and performance tracking through the Customer Relationship Management (CRM) applications.
• Remains up-to-date and adheres to quality standards, regulation, and all other policies to ensure quality, consistency, and compliance.
• Performs other duties as assigned.

Bilingual Customer Service Advocate – Mandarin

Project Manager

• Plan, organize, monitor, and oversee complex projects utilizing cross functional teams to deliver defined requirements and meet company strategic objectives
• Support accreditation readiness activities, including evidence coordination, tracking of requirements, and cross-functional collaboration related to NCQA standards.
• Manage the full project life cycle including requirements gathering, creation of project plans and schedules, obtaining and managing resources, managing budget, and facilitating project execution, deployment and closure.
• Utilize corporate and industry standard project management tools and techniques to effectively manage projects.
• Assist with establishment and maintenance of corporate project management methodology and other department procedures
• Maintain detailed project documentation including meeting minutes, action items, issues lists and risk management plans.
• Provide leadership and effectively communicate project status to all stakeholders, may include written executive summaries.
• Negotiate with project stakeholders to identify resources, resolve issues, and mitigate risks.
• Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and company's objectives.
• Provide functional and technical knowledge across multiple business and technical areas.
• Monitor the creation of all project deliverables to ensure adherence to quality standards including design documents, test plans, training materials, and operations documentation.

Project Manager III, Accreditation

Artificial Intelligence

• Ensures AI applications, products, and solutions adhere to established company policies, regulatory requirements, and industry best practices
• Conducts compliance assessments, performs risk evaluations, and reviews and assesses AI systems to identify potential issues both before and after deployment
• Works closely with AI development teams, data scientists, and business stakeholders to support responsible AI practices while documenting findings and recommendations in clear, evidence based, and actionable reports
• Performs compliance reviews of AI applications and products to assess alignment with internal policies, governance standards, and standard operating procedures, including verification of required documentation, approvals, and controls prior to production deployment
• Conducts structured risk assessments of AI systems across their lifecycle, identifying and documenting risks related to bias, privacy, security, safety, model behavior, and regulatory non compliance; evaluate risk likelihood, impact, and adequacy of mitigation controls
• Reviews model development practices, data handling procedures, deployment controls, and technical artifacts (e.g., model cards, system architecture documentation) to identify compliance gaps and discrepancies between documented capabilities and actual system behavior
• Investigates AI system incidents, complaints, or governance concerns by analyzing system behavior, data flows, and decision logic; document investigative methods, evidence reviewed, and conclusions reached
• Conducts hands on testing and probing of AI systems to validate documented claims regarding performance and behavior, and support ongoing monitoring of deployed systems
• Tracks compliance and risk findings, remediation actions, and residual risk through maintained risk registers and supporting documentation; verify corrective actions are implemented and documented
• Partners with AI development teams, product owners, and subject matter experts to gather information for assessments and investigations, and prepare clear findings, executive summaries, and recommendations for leadership and governance stakeholders
• Monitors trends in compliance and risk findings to identify systemic issues and support continuous improvement of AI governance practices; stay current with evolving AI regulations, standards, and industry best practices
• Performs other duties as assigned
• Complies with all policies and standards.