Centene Corporation

Business Analyst

• Perform various analysis and interpretation to link business needs and objectives for assigned function.
• Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems.
• Identify and analyze user requirements, procedures, and problems to improve existing processes.
• Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations.
• Identify ways to enhance performance management and operational reports related to new business implementation processes.
• 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.
• Diagnose problems and identify opportunities for process redesign and improvement.
• Formulate and update departmental policies and procedures.
• Serve as the subject matter expert on the assigned function product to ensure operational performance.

Business Analyst III, Hedis, SQL

Marketing

• Support the California Marketing department needs including product, operations, project management and all other activities related to marketing and communications
• Update project tracking for various topics using the project management templates developed
• Assist with approval need for various material, including uploading into our review and approval system
• Support promotional and print product pricing, ordering, and distribution
• Develop department documents such as contact and vendor lists; keep these lists updated
• Develop and implement a department CNET strategy and ensure the site is kept updated
• Track competitor activities, including developing a way to track and report findings
• Support department on various other projects and perform some administrative work

Marketing Coordinator

Analyst

• identifies and presents business and operational specifications based on customer and business needs
• conducts assessment and monitoring of vendors performing outsourced activities
• ensures contract and quality standards are met
• implements processes, systems and methodologies to meet the company's business initiatives
• applies performance metrics and key performance indicators (KPI)
• monitors the productivity and quality of vendor services by analyzing data, reports and processes
• prepares reports on vendor performance to internal oversight committees
• assists in developing corrective action plans
• identifies systemic issues and develops and executes strategies to address these issues
• participates in cross-departmental implementation teams
• validates the accuracy of data and statistics

Vendor Performance Analyst

Systems Engineer

• Oversees the collection, analyzing, and monitoring of contact center activity data to recommend technology system improvements
• Ensures contact center systems are working efficiently and effectively while developing future solutions
• Oversees the effort in the implementation process and overall solution design
• Provides insight and guidance in analyzing, evaluating, and developing specifications and/or requirements of system
• Monitors ongoing process improvements, enhancements, and technology upgrades
• Oversees data analysis, user acceptance testing, and root cause process assessments
• Identifies opportunities based on insights synthesized from available reports and prior experience
• Prioritizes mitigation of system issues and process improvement with senior management
• Oversees implementation of business requirements into application definitions, workflows, business processes, and solutions
• Validates training material accurately reflect new features and system upgrades
• Reviews and refines user manuals and documentation on program development, logic, and coding
• Leads implementation of best practices for scalability, supportability, maintenance, and system performance

Lead Contact Center Systems Analyst

Medical Billing and Coding

• Conduct training needs analyses to determine specific training needs for Payment Integrity department staff
• Identify, select, and develop appropriate training programs, including the selection or design of appropriate training aids
• Evaluate effectiveness of training programs, including cost and benefit analyses
• Research, analyze and recommend external training programs
• Maintain records of training activities and employee progress
• Assist in auditing work performed by staff and present findings and recommendations for areas of improvement to management
• Assist with revisions to policy and procedures and/or work process development
• Performs other duties as assigned
• Complies with all policies and standards

Coder Trainer I

Account Executive

• Represent the company to all prospective and existing clients
• Monitor client satisfaction and recommend changes to enhance satisfaction
• Perform sales and marketing related activities on company programs and products
• Serve as the contact for client issues and inquiries and collaborate with various departments on resolutions
• Develop and maintain relationships with various levels of clients
• Attend patient care conferences and professional in-services

Account Executive II – Specialty Pharmacy

Chief Operating Officer

• A highly visible, strategic partner accountable for planning and executing key operational, strategic, and tactical priorities for Ambetter Health Solutions
• Identify and execute business strategies and operational plans to ensure successful growth, market positioning, compliance and profitability goals are met
• Work closely with the Ambetter Health Solutions President to define, align and influence business strategies
• Lead AOP financial plan and presentation with our Finance and Actuarial team members
• Develop and implement key metrics and performance standards to review and assess the performance of the product
• Collaborate with internal and external stakeholders, including market health plan leadership, vendors, and regulatory partners, to ensure seamless service delivery and continuous improvement
• Leverage data and identify trends to ensure expectations are met and provide regular updates to Ambetter leadership on performance trends and activities

Chief Operating Officer, ICHRA

• accountable for material development, creative review, regulatory review process oversight for Direct to Consumer and Field Sales campaigns
• Support the creative and regulatory review process by managing Direct to Consumer and Field marketing materials and campaigns
• Project manage creative and compliance for materials and campaigns in Workfront, ensuring marketing guidelines and material development processes are followed and CMS requirements are met
• Must possess excellent communication, project management and critical thinking skills, while working with many different teams
• Manage ad hoc project and communication requests to support the sales organization

Sales Execution Specialist

Vice President

• The Vice President of Quality Management has national responsibility for all aspects of the quality management program for the Health Plan Division (HPD) and maintaining NCQA accreditation status for each regional area
• Responsible for leading the organization in the development of effective and efficient business processes
• Leads the development and implementation of the HPD’s Quality Program and ensures national consistency of best practices for all members and providers
• Acts as advisor and consultant to business unit leadership on processed and outcomes related to the accreditation program
• Leads monitoring and audit preparation activities to ensure the health plan and contracted network processes are in compliance with regulatory and accreditation agencies
• Leads and oversees the Delegated Oversight Department and ensures delegated provider and clinical vendor performance are in compliance
• Leads and participates in national and regional committees that promote and oversee quality, accreditation programs and initiatives to monitor the quality of care, delivery and access
• Ensures compliance with company standards related to clinical measurement programs transparency, data exchange, ethics and public reporting
• Develops and implements provider education/intervention programs for aberrant or outlier care practices including development of clinical evidence-based clinical guidelines
• Participates in the implementation of medical program strategic development and deployment in collaboration with the Medical Integration team
• Programs include, but are not limited to, Wellness, Preference Sensitive Conditions, Disease State Management, Chronic Conditions and Special Populations
• Works collaboratively with various HPD departments to manage health care outcomes and trends including implementing mechanisms to leverage national and local network management agreements
• Leads the process to monitor the effectiveness of all quality-related programs
• Oversees the design, implementation and monitoring of enterprise-wide customer satisfaction measurement and initiatives to improve the customer’s perception of services
• Collaborates with national HEDIS team in the data collection process at the provider level and leads national/regional data analysis and member/provider strategy and interventions
• Directs the preparation of short-term and long-range plans and budgets
• Leads management of the quality team and drives staff development opportunities

Vice President, Quality Management

• Supports Account Executives and Account Management Teams in assigned territories for small group, mid-market, and large group segments
• Assists with new business, renewal presentations and broker service issues pertaining to ancillary products
• Meets or exceeds assigned annual sales goals
• Participates in product training with Sales Management
• Assists with supporting Health Plan’s General Agents and brokers
• Develops best practices and implements based on local market conditions
• Reviews and responds to RFP’s, manages internal strategy
• Maintains strong familiarity with competition, market environments, healthcare economics
• Builds relationships with Health Plan sales and account management teams
• Travels to customer, finalist and presale meetings

Account Executive II

Compliance

• Manage the compliance department functions including periodic monitoring and auditing activities
• Provide compliance oversight and execution of key Medical Loss Ratio (MLR) compliance activities
• Develop and maintain the MLR compliance oversight program
• Identify opportunities to improve business practices and processes
• Provide oversight of submission of timely and accurate contract and regulatory Medical Loss Ratio required report deliverables
• Conduct periodic Medical Loss Ratio assessments
• Assist in the creation and implementation of corrective action plans
• Collaborate with Health Plans and States for compliance
• Manage consumer and provider communication materials
• Support responses to RFPs and new business implementations
• Design, implement and improve processes to prevent, detect and respond to Medical Loss Ratio compliance issues
• Create and deliver Medical Loss Ratio compliance training

Senior Manager, Compliance – Medical Loss Ratio

Call Center Representative

• Oversees and offers guidance around current contact center operational processes
• Establish operational targets, best practices, and training programs that support service, quality, and efficiency standards
• Supports contact center staff with day-to-day oversight and resources for contact center operations
• Oversees daily operations of contact center teams by planning, directing, and evaluating team performance
• Monitors interactions, workflow, and metrics of the contact center
• Serves as primary point of contact for contact center and operations employees and resolves complex issues
• Manages and maintains policies, procedures, and regulations to ensure compliance requirements are achieved
• Provides training and coaching to direct reports for operational improvement within the contact center
• Evaluates contact center operations team on performance and provides feedback on improvement opportunity and career growth path
• Collaborates with training teams to develop, review, and approve of appropriate training materials and/or programs for contact center operations team members
• Supports contact center operations senior management with onboarding, hiring, and training new employees, recent promotes, and transfers to department
• Performs other duties as assigned

Supervisor, Contact Center Operations

Communications

• Strategize and manage member and provider materials while ensuring accuracy, clarity, and alignment with organizational standards
• Support the creation and implementation of new processes for document and content development, improving efficiency and consistency across teams
• Maintain and update content policies and procedures to reflect best practices and regulatory requirements
• Craft compelling narratives that articulate Centene's mission, vision, and values from a quality perspective
• Develop and coordinate execution of strategic communications plans for key quality initiatives and member communications that support enterprise-wide goals
• Lead process improvements to align enterprise initiatives with clear, consistent, and high-quality communications
• Help facilitate corporate review process for approval of materials to be sent to members and providers
• Establish process and standing meetings for bringing together document owners to review new content drafts and revisions

Quality Communications Strategist

Clinical Operations

• Lead the implementation of new auditing processes and staffing oversight for audits of specific Utilization Management, Care Management Appeals activities within the organization
• Provides guidance and oversight support of corrections identified by Utilization Management, Care Management, and/or Appeals leadership along with Compliance Officers regarding the requirements of accrediting and regulatory agencies
• Leads the daily operations management of associates who monitor compliance through business monitoring audits, staff performance quality audits, surveillance and defect reports
• Coordinates monthly and quarterly audit and business monitoring results to provide systemic results and highlight opportunities for improvement
• Ensures team is operating at high standards with minimal overturn of results based on internal standards
• Implements audit programs to ensure compliance with all operational processes
• Provides feedback to leadership team regarding audit results, opportunities for improvement, and/or required Corrective Action Plans
• Leads Monitoring Teams responsible for research, education and conducts audits

Supervisor, Clinical Operations Oversight

Backend Engineer

• Analyze integrated and extensive datasets to extract value, which directly impacts and influences business decisions
• 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.