RN Care Manager – Pediatrics
Centene Corporation
Senior Manager, Claims Process Initiatives
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $105,600 - $195,400 per year
Job Level
Senior
About the role
- Serves as a critical resource in supporting, managing, and leading strategic projects and initiatives for the Claims functional business unit
- Supports leadership in executing business and technical strategies
- Oversees claims process governance, system integration, legal coordination, and compliance
- Builds strong relationships with key functional areas and provides leadership and oversight to staff
- Acts as a subject matter expert (SME) for claims operations, change control, and business implementations
- Leads Claims Process Change Control, including approval of process changes initiated internally or by partner organizations
- Provides claims input for business requirements related to system changes, upgrades, and partner initiatives
- Partners with Information Technology on automation and configuration updates
- Ensures integration across claims, eligibility, provider, and utilization management systems
- Oversees data/reporting integration to support operational and downstream needs
- Coordinates claims input for legal actions and builds frameworks for legal responses
- Reviews and approves business solutions and implementation requirements for new business
- Researches, defines, and manages business specifications for system infrastructures
- Maintains policies and specifications to accommodate regulatory or business changes
- Conducts contract reviews to identify and operationalize new or changing requirements
- Oversees project plans and tracks key milestones for claims readiness
- Provides claims operations expertise for RFPs, RFIs, and audit readiness
- Leads process improvement initiatives in collaboration with cross-functional teams
- Develops and maintains policies and procedures (P&Ps) ensuring compliance with state/federal regulations, contracts, and SLAs
Requirements
- Bachelor's Degree in a related field or equivalent experience required
- Master's Degree preferred
- 5+ years experience in claims system/administration, healthcare operations, or program management required
- Experience leading cross-functional teams and managing large-scale projects required
- 3+ years management experience required
- Regulatory knowledge of Medicare, Medicaid, and/or Marketplace required; experience with multiple products preferred
- Duals product/regulatory knowledge preferred
- Claims processing subject matter expertise highly preferred
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
claims system administrationbusiness specifications managementprocess change controldata integrationsystem integrationproject managementprocess improvementregulatory compliancecontract reviewclaims operations expertise
Soft skills
leadershiprelationship buildingcross-functional team managementcommunicationoversightstrategic thinkingcollaborationproblem-solvingorganizational skillschange management
Certifications
Bachelor's DegreeMaster's Degreeprogram management certificationhealthcare operations certification
