Centene Corporation

Manager

• responsible for negotiating agreements with integrated healthcare delivery systems, hospitals, ancillary providers, physicians and physician groups
• accountable for ensuring effective implementation of new and renewing contracts through communication and coordination with other functional areas
• create, negotiate and incorporate contract amendments, renegotiate the contract to accommodate scope changes or changes in organization requirements
• monitor provider contracts to ensure terms and conditions are met
• perform necessary analysis of cost and utilization data in addition to the analysis of the financial and operational impact of contractual proposals

Contracts Manager

Business Analyst

• Perform and lead various analysis and interpretation to link business needs and objectives for assigned function and implement process improvements
• Lead the support of business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems
• Lead the identification and analysis of user requirements, procedures, and problems to improve existing processes
• Resolve issues and identify opportunities for process redesign and improvement
• Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations, including improvements and revisions to business processes and requirements
• Evaluate risks and concerns and communicate to management
• Coordinate with various business units and departments in the development and delivery of training programs
• Develop, share, and incorporate organizational best practices into business applications
• Oversee all changes to departmental policies and procedures, including communicating and implementing the changes
• Serve as the subject matter expert on the assigned function product to ensure operational performance
• Ability to travel

Business Analyst IV – Process Improvement

Human Resources

• Independently supports and advances Human Resources (HR) Compliance Program by providing senior level expertise, regulatory analysis, and compliance oversight
• Advises HR and business stakeholders on complex HR compliance matters
• Leads monitoring and audit activities, and supports enterprise initiatives that strengthen compliance governance, risk mitigation, and operational consistency
• Operates with a high degree of autonomy and judgment and serves as a key partner to HR, Legal, and Compliance teams
• Independently monitors HR programs, processes, and documentation to assess compliance with internal policies and applicable regulatory requirements
• Develops and enhances HR compliance communications and training initiatives, providing subject matter expertise and guidance to the People Team, people leaders, and employees
• Serves as a subject matter resource for HR compliance risk areas
• Oversees internal and external HR compliance audit responses
• Provides senior level advisory guidance to HR and business stakeholders
• Independently maintains and continuously improves HR compliance documentation
• Leads routine and targeted audits of HR programs and processes
• Monitors regulatory developments and proactively assesses potential impacts to HR policies, practices, and programs
• Tracks and manages compliance deadlines, mandatory training requirements, regulatory reporting, and certification expirations
• Conducts in depth research on federal, state, and local HR compliance requirements

Senior Human Resources Compliance Analyst

Compliance

• Responsible for the remediation and reporting activities to ensure successful resolution of identified non-compliance with DSNP regulatory requirements, contractual obligations and Company policies and procedures
• Supports the internal and external corrective action plan lifecycle and related reporting
• Partners with Product Compliance teams, Shared Services leadership, and market leaders to ensure successful and timely remediation of identified compliance issues
• Collaborates with compliance and business stakeholders to ensure adequate root cause analysis and development of corrective actions plans
• Reviews and oversees progress towards remediation and documents key milestones in GRC tool
• Identifies issues that require escalation and ensures they are addressed timely through established paths and processes
• Conducts review of evidence to address root cause of issue and facilitate timely closure of issues
• Facilitates escalation of barriers identified by other Corrections staff
• Develops, implements and continually refines corrections reporting that provides meaningful trend analysis for business stakeholders and senior leadership on new, in progress and closed issues as well as regulatory sanctions
• Supports management in the development and maintenance of corrections processes and tools designed to effectively remediate compliance issues in a timely manner

Senior Compliance Administrator – DSNP

• Lead a team within Compliance Corrections responsible for the remediation and reporting activities to ensure successful resolution of identified non-compliance with Medicaid, Medicare, Marketplace, and Commercial regulatory requirements, contractual obligations and Company policies and procedures.
• Supports the internal and external corrective action plan lifecycle and related reporting.
• Partners with Product Compliance teams, Shared Services leadership, and market leaders to ensure successful and timely remediation of identified compliance issues.
• Lead and manage the assessment, and prioritization of non-compliance issues referred to the Corrections team.
• Oversee the execution and continuous improvement of the Corrections Compliance program, ensuring alignment with organizational standards.
• Provide regular updates on program performance to senior management and key stakeholders.
• Recruit, supervise, and develop team members in support of the organization’s mission and culture.
• Identify and recommend strategic improvements that significantly impact organizational goals and performance.
• Respond to inquiries from internal stakeholders and leadership regarding compliance matters.
• Offer expert guidance to departments on non-compliance issues and the progress of remediation efforts.
• Influence management to enhance performance and support leadership in achieving organizational objectives.
• Foster trusted, collaborative relationships with leadership to ensure active engagement in the Corrections process.
• Serve as the designated point of contact in the absence of the Senior Director of Compliance Corrections.
• Performs other duties as assigned. Complies with all policies and standards.

Senior Manager, Enterprise Compliance Corrections

• Executes defined compliance activities, responding to inquiries, and assisting with monitoring, audits, and reporting processes.
• Works under established policies, procedures, and guidance to help ensure HR programs and practices align with internal requirements and applicable regulatory obligations.
• Partners with HR, Legal, and Compliance stakeholders, escalating issues and risks as identified.
• Conducts periodic, guided reviews of HR programs, processes, and documentation to support compliance with internal policies and regulatory requirements.
• Partners with HR, Legal, and business leaders to ensure consistent and compliant employment practices across the organization and supports remedial activities.
• Supports HR compliance communications and training initiatives for the People Team, people leaders, and employees.
• Supports internal and external HR compliance audits by gathering documentation, preparing audit responses, and assisting with tracking remediation and follow up actions.
• Manages and resolves HR compliance escalations and inquiries with minimal guidance.
• Assists with maintaining HR compliance documentation, including policies, procedures, and required records.
• Supports routine audits of HR files and processes to ensure accuracy and adherence to established requirements.
• Reviews and responds to HR compliance inquiries received through shared mailboxes or ticketing systems.
• Tracks compliance deadlines, mandatory training requirements, regulatory reporting obligations, and certification expirations.
• Assists with researching federal, state, and local HR compliance requirements and summarizes findings for review by senior team members.

Human Resources Compliance Analyst

• A member of the Compliance Corrections team responsible for the remediation and reporting activities to ensure successful resolution of identified non-compliance with Marketplace and Commercial regulatory requirements, contractual obligations and Company policies and procedures.
• Supports the internal and external corrective action plan lifecycle and related reporting.
• Partners with Product Compliance teams, Shared Services leadership, and market leaders to ensure successful and timely remediation of identified compliance issues.
• Collaborates with compliance and business stakeholders to ensure adequate root cause analysis and development of corrective actions plans to effectively address non-compliance.
• Reviews and oversees progress towards remediation and documented key milestones in GRC tool.
• Identifies issues that require escalation and ensures they are addressed timely through established paths and processes.
• Conducts review of evidence to address root cause of issue and facilitate timely closure of issues.
• Facilitates escalation of barriers identified by other Corrections staff.
• Develops, implements and continually refines corrections reporting that provides meaningful trend analysis for business stakeholders and senior leadership on new, in progress and closed issues as well as regulatory sanctions.
• Supports management in the development and maintenance of corrections processes and tools designed to effectively remediate compliance issues in a timely manner, ensure timely escalation and sustainable resolutions.
• Educates, encourages, and assists those within the company to maintain integrity through correction of identified non-compliance to meet the requirements of Government-sponsored health care programs.
• Performs other duties as assigned.
• Complies with all policies and standards

Senior Compliance Administrator – Corrective Action Plans

Customer Support

• Supports Ambetter Brokers and the Sales team with commission & contracting related questions
• Collaborates with leadership team and internal teams on member related issues
• Partners with Sales team to make outreaches to brokers to secure and retain membership
• Handles provider issues that brokers call or email about
• Researches commission issues to determine broker commission payments
• Performs other duties as assigned and complies with all policies and standards

Broker Sales Support Specialist I

Communications

• Oversee digital communications strategy, ensuring solutions and initiatives are aligned to business objectives that lead to improved audience engagement and business growth
• Establish and oversee a multi-year digital communications strategy and roadmap, partnering with key stakeholders to align on enterprise initiatives
• Work closely with technology teams to ensure communications and engagement platforms and functionality meet strategy needs
• Partner with key business and technology teams, ensuring robust data infrastructure, champion data-driven insights, build reporting/dashboards, and maintain data governance/privacy compliance
• Develop and oversee technical processes, aligning with communications architecture and governance to optimize the use of communications and marketing technology
• Drive the development of automated workflows for digital communications processes, fostering experimentation and continuous improvement
• Evaluate and recommend emerging technologies and innovations to enhance personalization and operational efficiencies

Director, Digital Communications Strategy

Risk

• Supports the Senior Director in driving the strategy, execution, and ongoing enhancement of the organization's third‑party risk management program.
• Helps translate the strategic vision into operational plans, overseeing key components of due diligence, risk assessments, compliance monitoring, and performance evaluation across the third‑party lifecycle.
• Leads issue management activities, supports cross‑functional initiatives that strengthen risk transparency, and ensures adherence to regulatory, contractual, and accreditation requirements.
• Contributes to executive‑level reporting, supports internal and external audits, optimizes program operations, and develops team members to advance a culture of accountability and continuous improvement.
• Assists with defining the strategic vision, operating model, and organizational roadmap for the third party risk management program, ensuring alignment with enterprise priorities and regulatory and accreditation obligations.
• Leads the development, execution, and continuous refinement of a comprehensive third party risk management framework, a risk-based annual audit plan that adapts to emerging risks and changes within third party operations.
• Evaluate third party compliance and performance by conducting preservice, annual, risk-based audits, and monitoring activities.
• Oversees the full lifecycle of due diligence, compliance monitoring, and performance assessment of third parties, ensuring alignment with contractual, regulatory, and accreditation requirements.
• Drives operational effectiveness by optimizing program resources and strengthening workforce capabilities.
• Leads development and delivery of executive level reporting and dashboards with insights for senior leadership and the board.

Director, Third Party Risk Management

Financial Planning and Analysis

• Oversee, maintain and update budget systems
• Analyze monthly reports and update company forecast models
• Develop and analyze budget and financial forecast processes for Medicare
• Review Medicare SG&A reporting and obtain data required for planning work function activities
• Disseminate relevant financial information to business unit leaders for effective decision making
• Evaluate and update policies and procedures to improve quality and ensure compliance with all related laws, regulations and executive orders

Senior Manager, Financial Planning – FP&A/Medicare

Director

• Creates and implements Network Transformation initiatives across a market
• Develops Provider Relations Management team to effectively achieve market targets
• Conducts field rides with Provider Relations Representatives to gauge their performance
• Monitors Provider Performance action plans and tracks provider performance improvement
• Establishes and leads collaborative effort with internal cross-functional market departments

Senior Director, Provider Relations

• Leads the organization's framework for evaluating, monitoring, and mitigating risks across all third‑party relationships.
• Oversees due diligence, ongoing monitoring, issue management, and audit readiness to ensure compliance with operational, contractual, and regulatory requirements.
• Partners with cross‑functional teams to drive timely risk mitigation and provides clear reporting and insights to senior leadership.
• Develops a high‑performing team and optimizes resources to support a robust and efficient third‑party risk management program.
• Implement and maintain the third-party risk management framework, policies, and procedures to ensure consistent and effective oversight.
• Monitor third party performance by conducting pre service, annual, and risk based audits, as well as ongoing monitoring activities, to evaluate adherence to expectations, policies, procedures, and regulatory & accreditation requirements.
• Execute issue management activities by identifying issues, recommending actionable remediation plans, monitoring corrective actions, and reporting progress to stakeholders.
• Lead comprehensive risk assessments and due diligence processes for new and existing third parties, ensuring identification and evaluation of operational, compliance, and financial.
• Coordinate with cross functional partners (e.g., Operations, IT Security, Procurement, Compliance) to identify, assess, and manage third party risks, facilitating alignment and timely action across teams.
• Prepare and deliver operational reports, dashboards, and insights to senior leadership and the board of directors to support transparency, accountability, and strategic planning.
• Support internal and external audits related to third party oversight by maintaining required documentation, working with third parties to ensure timely responses, performing quality reviews, and preparing materials for audit stakeholders.
• Monitor the timely receipt and accuracy of all regulatory and contractual reports required from third parties to ensure compliance with obligations.
• Serve as a liaison and subject matter resource to third parties by communicating contractual and regulatory requirements, as well as new or revised expectations.
• Manage and develop direct reports—including supervisory or managerial personnel—by setting clear expectations, coaching performance, and fostering a culture of accountability, capability growth, and continuous improvement.
• Develop and mentor a team of individual contributors that support third party risk management processes, promoting operational excellence and professional development.
• Optimize resource allocation to ensure effective support of third party risk management program activities and overall functional efficiency.

Senior Manager, Third Party Risk Management

Vice President

• Oversee all related activities for the Quality Improvement functions
• Lead and direct process improvement activities for more efficient and streamlined workflow
• Oversee the business processes related to risk adjustment and quality improvement for assigned products and plans
• Responsible for all activities related to NCQA Accreditation and/or HEDIS performance ensuring highest level of accreditation
• Manage all aspects of HEDIS improvement activities, including outreach, incentives, data integrity and chart review
• Review and implement new technological tools and processes and foster team concept with internal and external constituencies
• Present results of improvement efforts and ongoing performance measures and recommend actions plans to senior management
• Research and incorporate quality improvement best practices into operations
• Organize and control activities, methods, and procedures to achieve business objectives
• Formulate and establish policies, operating procedures, and goals in compliance with internal and external guidelines
• Manage and ensure compliance of EPSDT program as well as compliance and turnaround time of grievances and appeals

Vice President, Quality Improvement

Operations

• Support pharmacy benefit management, specific to pharmacy benefits
• Troubleshoot and resolve request related to pharmacy benefit setup
• Research and analyze reported inquiries and issues by interpreting requests, documentations, and communications from internal and external partners
• Manage multiple tasks through a ticketing system and additional responsibilities
• Analyze and troubleshoot claim issues using available tools and data
• Use excel daily to analyze and validate complex data sets
• Conduct claims analysis
• Review benefit/formulary setup and testing (new and year over year)