Centene Corporation

Manager

• Manage and develop data necessary to analyze trends over various timeframes
• Manage the data mining process and analysis using internally supported database programs
• Collaborate with various departments and other key business units to identify areas for process improvement initiatives
• Manage staff to ensure the accuracy and timeliness of data requests
• Evaluate reports produced by the Quality Initiative (QI) Department and other various departments for trends and opportunities for improvement
• Mange the design of tools and databases to capture and track data, methodologies, findings and analysis and ensure data collection/extractions, analysis and submissions meet regulatory compliance requirements
• Monitor data and information to assist QI department staff members in improving HEDIS and other required measures
• Research and establish benchmarks and statistics for quality measures
• Develop, prepare and present reports on quality programs and issues to both internal and external stakeholders
• Evaluate and test new or modified programs and procedures used to verify that QI functions and conforms to established guidelines

Manager, Quality Improvement Analytics

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
• 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
• Complies with all policies and standards

Customer Service Advocate I – Bilingual Mandarin

Operations

• Oversee department staff including hiring, performance management and career development to ensure alignment with defined goals
• Develop budgets and priorities, ensuring plans and resource allocations are consistent with those budgets and priorities
• Determine the organization’s long-term systems and/or hardware needs to accomplish the organization’s business objectives
• Analyze the needs of departments and establish priorities for feasibility studies, systems design, and implementation to develop new and/or modify the company’s information processing systems and policies and procedures
• Responsible for the plans and activities of the organization with senior leaders inside and outside IT, as well as strategic suppliers
• Apply process and business expertise to impact business results

Vice President – BTS Technical Operations Services

• Provide case management and service coordination to members living with mental illness and/or substance abuse disorders.
• Develops, assesses and coordinates holistic care management activities.
• Evaluates member service needs and develops or contributes to development of care plans/service plans.
• Acts as liaison and member advocate between the member/family, physician, and facilities/agencies.
• Supports members with primarily mental/behavioral health needs.
• Performs frequent home and/or other site visits to assess member needs and collaborate with resources.
• Educates on and coordinates community resources.
• Maintains accurate documentation and supports the integrity of care management activities.

Psych RN, Care Manager

• Assists in developing, assessing, and coordinating holistic care management activities
• Develops personalized service care plans/service plans for long-term care members
• Evaluates the needs of the member and recommends/facilitates plans for the best outcome
• Coordinates between members and care provider teams
• Provides resource support for various needs
• Monitors care plans/service plans and provides recommendations
• Interacts with long-term care healthcare providers and partners
• Collects and maintains long-term care member information
• Performs home and/or other site visits
• Facilitates education to members and families/caregivers
• Provides feedback to leadership on opportunities to improve care and service delivery.

LTSS Service Care Manager

Compliance

• Supports the execution and day-to-day administration of Centene’s Ethics & Compliance Program
• Provides highly organized operational, communication, documentation, and coordination support across governance operations
• Tracking timelines, deliverables, dependencies, and escalating risks or issues
• Draft, organize, and distribute clear, accurate, and timely Compliance communications, meeting materials, and program documentation
• Maintain organized, accurate Compliance documentation, templates, trackers, and repositories
• Build, maintain, and organize Compliance SharePoint sites, libraries, and content

Compliance Analyst – Compliance Program Administration

Security Engineer

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Data Security Engineer II

Director

• Drive the vision, strategy, and execution of ICHRA-focused products that enhance market competitiveness and deliver measurable value to customers and business.
• Lead the development and optimization of ICHRA product portfolios by identifying emerging opportunities, shaping differentiated solutions, and ensuring alignment with organizational goals.
• Advance a culture of innovation by championing new ideas, testing concepts, and accelerating the successful adoption of high impact initiatives.
• Lead the development and execution of the ICHRA business strategy, with accountability for growth, scalability, and long term sustainability.
• Build, strengthen, and optimize the ICHRA carrier and provider network to ensure competitive offerings, coverage adequacy, and affordability.
• Identify market opportunities, employer segments, and growth levers to expand ICHRA adoption across targeted populations.
• Translate enterprise strategy into actionable strategies, milestones, and performance outcomes.
• Serve as a strategic thought partner to executive leadership on ICHRA positioning, competitiveness, and innovation.
• Partner closely with Network, Product, and Actuarial teams to design solutions that meet employer and employee needs while maintaining compliance and financial discipline.
• Provide oversight of ICHRA related contracts, including carrier agreements, vendor partnerships, and third party administrators.
• Communicate ICHRA strategy, performance, and risks to leaders and stakeholders.
• Provide clear, data driven insights to support decision making and investment priorities.
• Remove barriers to execution and drive alignment across stakeholders with competing priorities.
• Ensure operational readiness and scalability as the ICHRA business grows.
• Partner with Legal, Compliance, and Procurement to mitigate risk and ensure contractual consistency and governance.
• Performs other duties as assigned. Complies with all policies and standards.

Senior Director, Product & Innovation, ICHRA

Risk

• Oversee and monitor the performance of both internal and external cost recovery and cost containment initiatives according to targeted project metrics and forecasted recovery and cost avoidance goals for each Health Plan
• Manage internal and external vendors cost avoidance and cost recovery initiatives
• Partner with health plans to identify and contain cost through collaboration with national vendors for each recovery category
• Develop annual budget and projected target for each national vendor and assist them with achieving projected annual savings
• Evaluate and streamline existing processes and implement new processes to reduce costs
• Present trends and cost containment opportunities, recommend action plans, and assist with the implementation of those plans
• Assist health plans in understanding the rules, regulations and processes around cost recovery
• Monitor other departments’ performance and processes and evaluate for cost recovery
• Compile and Present reporting packages for Senior Management on current cost avoidance and cost recovery initiatives

Senior Manager, Payment Integrity Governance

• Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends/schemes
• Monitor business processes and systems to assure integrity and compliance in billing and claims payment
• Lead teams of analysts to appropriately investigate all possible fraud, waste and abuse referrals
• Develop customized fraud plans to meet contract and federal requirements
• Develop educational materials to identify/validate waste activities as requested by the health plan and on an ad-hoc basis
• Respond to RFP request and implement new policies per contractual obligation
• Attend state/federal meetings as required by specific contracts
• Prepare/present the FWA program to state/federal personnel upon request, specifically during readiness reviews, and immediately following the go live or upon state agency personnel changes
• Review post-payment cases with appropriate parties to obtain refund
• Prepare and distribute monthly and quarterly saving reports

Manager, Payment Integrity Governance

Data Engineer

• Manages the overall data platform and infrastructure and mentors the team of data engineers.
• Supports developing processes, and expanding technology roadmap, planning features, measuring outputs, and ensuring quality products.
• Derives analytical insights from a variety of business contexts and communicates those insights effectively to a variety of stakeholders.
• Establishes the planning, prioritization and execution of data production projects and processes.
• Builds and establishes the standards and processes required to ensure the delivery of high-quality data products.
• Oversees the automation of key ETL / ELT processes for large volumes of data and migrations of workloads.
• Establishes and implements data governance, data quality, integrity, standards, master data management, metadata strategy, and business intelligence/analytics.
• Makes decisions on key technology choices for data pipelines.

Senior Manager, Data Engineering

Financial Planning and Analysis

• Oversee and monitor the performance of both internal and external cost recovery and cost containment initiatives according to targeted project metrics and forecasted recovery and cost avoidance goals for each Health Plan.
• Manage internal and external vendors cost avoidance and cost recovery initiatives.
• Partner with health plans to identify and contain cost through collaboration with national vendors for each recovery category.
• Develop annual budget and projected target for each national vendor and assist them with achieving projected annual savings.
• Evaluate and streamline existing processes and implement new processes to reduce costs.
• Present trends and cost containment opportunities, recommend action plans, and assist with the implementation of those plans.
• Assist health plans in understanding the rules, regulations and processes around cost recovery.
• Monitor other departments’ performance and processes and evaluate for cost recovery.
• Compile and Present reporting packages for Senior Management on current cost avoidance and cost recovery initiatives.

Senior Manager, Payment Integrity, Finance

• Oversee and optimize the delivery of a portfolio of Payment Integrity initiatives by providing strategic direction, governance, and execution leadership.
• Provide oversight and strategic direction for Payment Integrity implementation sub portfolios
• Establish delivery standards, governance structures, and performance metrics across implementation teams
• Lead prioritization, intake, and sequencing of initiatives to align with organizational goals and capacity
• Partner with executive leadership, health plans, and vendors to resolve complex delivery challenges
• Identify and drive process improvements that increase efficiency, scalability, and implementation quality
• Monitor portfolio health including risks, dependencies, timelines, and outcomes
• Ensure consistent reporting, executive level summaries, and issue escalation across sub portfolios
• Mentor and develop managers and team members in delivery leadership and process discipline
• Complies with all policies and standards

Senior Manager, Payment Integrity – Implementation Delivery

Communications

• Support the planning, development, and execution of clear, consistent, and compliant communications.
• Coordinate with subject matter experts and training teams across impacted functional areas.
• Ensure providers and internal stakeholders receive accurate, timely, and easy-to-understand information.
• Develop and distribute communication materials.
• Coordinate review and approval of communication materials with internal departments.
• Develop, review and revise materials while ensuring appropriateness of content and readability.
• Maintain knowledge of federal and state regulatory requirements for communications materials.
• Coordinate with external vendors for translation of communications materials.
• Develop, coordinate approval, and distribution of employee communications.
• Perform other duties as assigned.