Centene Corporation

Manager

• Provide strategic leadership for teams performing advanced, complex claim reviews
• Ensure review accuracy, regulatory compliance, and achievement of payment integrity goals
• Analyze performance trends and standardize review processes and methodologies
• Implement consistent clinical and coding review methodologies
• Deliver actionable insights to shape operational strategies and informed decision-making
• Monitor and optimize business processes and systems for billing and claims payment accuracy, compliance, and integrity
• Lead and mentor teams conducting advanced coding and clinical validation reviews
• Develop and maintain standardized documentation supporting business objectives and consistent review outcomes
• Collaborate with cross-functional stakeholders to identify process improvements and champion innovative solutions
• Assign priorities, set goals, and coordinate daily team activities
• Maintain transparent communication through regular one-on-one and team meetings
• Establish and oversee the end-to-end Payment Integrity audit program lifecycle
• Set strategic audit direction, manage and develop teams, and ensure regulatory, contractual, and organizational compliance
• Apply expertise in ICD-10 coding, clinical guidelines, and Centene/Health Plan policies to guide review outcomes
• Incorporate CMS updates, state regulations, and contractual obligations into operational decisions
• Drive documentation initiatives and identify high-value review opportunities within the complex review roadmap
• Analyze audit trends and DRG adjustments to inform scalable program development
• Identify emerging opportunities within DRG and other review types
• Oversee program expansion through new complex review types and cross-departmental collaboration
• Integrate robust review protocols for audit operations
• Perform other duties as assigned
• Comply with all policies and standards

Manager, Clinical – Coding Review

Social Media Manager

• Collaborate on implementing and maintaining Centene’s corporate social media strategy
• Manage daily, weekly, and monthly social media components supporting the communications department mission
• Manage enterprise social media operations, including intake, content publishing, channel maintenance, asset management, and cross-functional coordination
• Establish, maintain, and review Centene social media accounts
• Monitor all Centene social media channels in real time and escalate concerns
• Develop and implement enterprise social media best practices
• Analyze social media trends using analytics tools and report findings to management
• Research social media trends and best practices to identify opportunities for enhanced interaction
• Maintain documentation for enterprise social media tools and best practices
• Develop content, messaging, and visuals for designated social media outlets
• Coordinate content reviews with subject matter experts, leaders, and other stakeholders
• Manage content posting and tagging on Centene’s social channels to support metrics gathering
• Execute CNC, ELT, and competitive reporting and analytics with social managers
• Collaborate on community management and response protocols
• Assess State Health Plan social content for engagement, amplification, and curation

Social Media Specialist

Data Analyst

• Analyze integrated and extensive datasets to extract value
• Work collaboratively with key business stakeholders to identify areas of value, develop solutions, and deliver insights to reduce overall cost of care for members and improve their clinical outcomes
• Interpret and analyze data from multiple sources including claims, provider, member, and encounters data
• Identify and assess the business impact of trends
• Develop, maintain, and troubleshoot complex scripts and reports developed using SQL, Microsoft Excel, or other analytics tools
• Contribute to the planning and execution of large-scale projects with limited direction from leadership
• Assist in the design, testing, and implementation of process enhancements and identify opportunities for automation
• Identify and perform root-cause analysis of data irregularities and present findings and proposed solutions to leadership and/or customers
• Manage multiple, variable tasks and data review processes with limited supervision within targeted timelines and thrive in a demanding, quickly changing environment
• Demonstrate a sense of ownership over projects and ask probing questions to understand the business value of tasks
• Apply expertise in quantitative analysis, data mining, and the presentation of data to see beyond the numbers and understand how customers interact with analytic products
• Partner cross-functionally at all levels of the organization and effectively, both verbally and visually, communicate findings and insights to non-technical business partners
• Independently engage with customers and business partners to gather requirements and validate results
• Communicate and present data-driven insights and recommendations to both internal and external stakeholders, soliciting and incorporating feedback when required
• Provide technical guidance to junior analysts

Data Analyst III – Healthcare Analytics

Program Manager

• Lead large‑scale, cross‑functional projects supporting Gold Card program implementation, ongoing operations, and process improvement, including collaboration with organizational leaders on team restructuring and realignment as needed.
• Oversee all aspects of program planning and execution, including scope, schedule, budget, dependencies, and resource alignment, ensuring adherence to project management standards.
• Drive complex initiatives by coordinating and overseeing the work of project managers and business analysts across multiple workstreams (e.g., Operations, Finance, Benefit Operations, Analytics, Configuration, Regulatory).
• Provide shared operational support for National and regulatory Gold Card programs, coordinating day‑to‑day activities across analytics, configuration, operations, and other supporting teams.
• Maintain centralized Gold Card program data, monitoring inputs, documentation, and regulatory artifacts, ensuring accuracy, consistency, and readiness for program use, audits, and executive review.
• Establish and maintain operational processes, templates, and reference materials to ensure standardization and accessibility for all relevant stakeholders.
• Support annual reassessment cycles and recurring audit activities through timely coordination of data, documentation, and cross‑functional inputs.
• Create and maintain reliable tracking mechanisms to provide visibility into in‑flight work across Gold Card initiatives.
• Develop executive‑level dashboards and status reporting that clearly communicate program health, milestones, risks, and outcomes.
• Partner with analytics teams to develop reports and dashboards to support ongoing monitoring, performance evaluation, and post‑implementation insights.
• Proactively manage program risks, issues, dependencies, and budget forecasts across Gold Card initiatives.
• Serve as the first point of escalation for program risks and issues; work directly with project teams to resolve challenges and develop risk mitigation strategies.
• Prepare and deliver well‑structured materials for Program Steering Committees and executive leadership, including risk assessments, decision points, and progress updates.
• Effectively communicate business and operational impacts, regulatory considerations, and proposed solutions to senior leaders.
• Create and deliver best‑practice guidance and program training to indirect reports, peers, and stakeholders, as applicable.
• Partner with training teams to develop, review, and maintain Gold Card–specific training materials to support operational readiness and ongoing adoption.

Program Manager IV – Gold Card Program

General

• Analyze and resolve verbal and written claims and authorization appeals from providers
• Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
• Prepare response letters for member and provider complaints, grievances and appeals
• Maintain files on individual appeals and grievances
• May coordinate the Grievance and Appeals Committee
• Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
• Assist with HEDIS production functions including data entry, calls to provider’s offices, and claims research
• Manage large volumes of documents including copying, faxing and scanning incoming mail
• Performs other duties as assigned
• Complies with all policies and standards

Grievance & Appeals Coordinator I

Clinician

• Perform medical necessity reviews and authorization determinations
• Monitor and determine if level of care and services related to mental health and substance abuse are medically appropriate
• Evaluate member’s treatment for mental health and substance abuse before, during, and after services
• Perform prior authorization reviews related to mental health and substance abuse to determine medical appropriateness
• Perform concurrent review of behavioral health (BH) inpatient
• Analyze BH member data to improve quality and appropriate utilization of services
• Provide education to providers, members, and their families regarding BH utilization process
• Interact with BH healthcare providers and engage with medical directors and leadership to improve quality

Utilization Review Clinician – Behavioral Health

Financial Planning and Analysis

• Compile and analyze financial information for the company
• Lead various financial projects
• Create and analyze monthly, quarterly, and annual reports
• Identify trends and developments in competitive environments and presents findings to senior management
• Assist with the review and validation of contractor requests, extensions, statements of work (SOWs), and professional services agreements
• Prepare journal entries, accruals, reconciliations, and supporting schedules related to labor and project accounting
• Support labor reporting processes, including internal labor, contractor labor, and professional services spend
• Identify and implement process improvements to enhance reporting accuracy, efficiency, and financial controls
• Develop and maintain financial models, dashboards, and management reports
• Collaborate with cross-functional teams including Technology, Procurement, Portfolio Management and HR to resolve financial issues and support decision-making
• Assist with the preparation of labor forecasts, budgets, and variance analyses for internal and external labor resources
• Analyze actual labor spend, labor utilization, contractor costs, and workforce trends to identify risks and opportunities
• Support monthly, quarterly, and annual financial planning processes, including budget development and forecast updates
• Monitor and report on labor-related financial metrics, including headcount

Finance Analyst III

Supervisor

• Oversee the day-to-day work functions of the assigned claims area
• Provide technical and leadership support to staff to resolve complex issues
• Develop and implement policies and procedures that comply with state and federal regulations
• Help to identify opportunities for improvements and resolve operational gaps/problems with a financial, regulatory, cost/benefit and stakeholder experience
• Serve as a point of escalation for complex claims
• Monitor claims quality reviews for accuracy, document results and identify trends and systemic root cause analysis
• Prepare reporting, analysis and insights that is consistent with defined standards to drive operational excellence
• Maintain appropriate records, files, documentation, etc.

Claims Supervisor

Medical Director

• Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit.
• Provide medical leadership for utilization management, cost containment, and medical quality improvement activities.
• Perform medical review activities for utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.
• Support effective implementation of performance improvement initiatives for capitated providers.
• Assist Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness.
• Provide medical expertise in the operation of approved quality improvement and utilization management programs.
• Conduct regular rounds to assess and coordinate care for high-risk patients.
• Collaborate with clinical teams and providers for reviewing complex cases and appeals.
• Participate in provider network development and new market expansion.
• Assist in the development and implementation of physician education on clinical issues.
• Identify clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice.
• Interface with physicians and providers to facilitate recommendations for improvement.

Medical Director, Marketplace

Claims Specialist

• Ensure timely processing of pending medical claims
• Verify and update information on the submitted claims
• Review work processes to determine reimbursement eligibility
• Ensure payments and/or denials are made in accordance with company protocols and procedures
• Process first time claims
• Apply policy and provider contract provisions to determine if claim is payable
• Research and determine status of medical related claims
• Maintain records, files, and documentation as appropriate
• Meet and maintain department production and quality standards
• Successfully complete additional progressive claims training programs as required
• Performs other duties as assigned
• Complies with all policies and standards

Claims Analyst

Auditor

• Perform internal audits, including the execution of information technology, strategic, operational, and compliance risk-based audits.
• Execute risk-based audits evaluating controls and processes for scalability, effectiveness, efficiency, and risk mitigation strategies
• Assist in audit planning, refinement of audit work programs, and wrap up of engagements
• Assist in drafting audit reports that summarize audit findings and recommendations, including consolidation of metrics and graphing
• Develop and communicate audit observations, recommendations, process improvement opportunities, and best practices and obtain management responses
• Monitor and report on the status and findings of audits
• Assist audit team in performing special projects and implementing internal audit best practices
• Performs other duties as assigned
• Complies with all policies and standards

IT Auditor II

• support the financial performance and operational analytics for business operations
• compile and analyze volume, productivity, staffing, savings, vendor, and cost data
• build recurring reports and executive-ready presentations
• maintain trackers; validating assumptions with operational partners; identifying trends, risks, and opportunities
• support forecast and reconciliation work; and translating complex financial and operational data into clear insights and recommendations for leadership
• handle complex and high-level financial analysis
• present and discuss analysis with upper management

Project Manager

• Plans, organizes, monitors, and oversees projects utilizing cross functional teams
• 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
• Maintain detailed project documentation including meeting minutes, action items, issues lists, and risk management plans
• Effectively communicate project status to all stakeholders
• 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
• Create and communicate project milestone documents, dashboards, ROI tables, and departmental success metrics

Project Manager II

• Plans, organizes, monitors, and oversees projects utilizing cross functional teams to deliver defined requirements and meet company strategic objectives
• 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
• Effectively communicate project status to all stakeholders
• 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
• Create and communicate project milestone documents, dashboards, ROI tables, and departmental success metrics

Project Manager II – Payment Integrity

• Performs reviews of member's care and health status of ABA services
• Monitors clinical effectiveness and efficiency of member's care
• Evaluates member’s care and health status before, during, and after provision of ABA services
• Analyzes BH member data to improve quality and appropriate utilization of services
• Provides education to members and their families regarding ABA and BH utilization process

Manager, Clinical – Coding Review

Social Media Specialist

Data Analyst III – Healthcare Analytics

Program Manager IV – Gold Card Program

Grievance & Appeals Coordinator I

Utilization Review Clinician – Behavioral Health

Finance Analyst III

Claims Supervisor

Medical Director, Marketplace

Claims Analyst

IT Auditor II

Finance Analyst III

Project Manager II

Project Manager II – Payment Integrity

Utilization Review Clinician – ABA