Centene Corporation

Network Engineer

• Provides leadership and guides in developing and coordinating network strategies for the full lifecycle of certificate management.
• Solutions for enterprise infrastructure, including LAN/WAN and third-party network management in support of Centene's business objectives.
• Manages strategic business relationships with technology vendors, suppliers, internal and external business partners.
• Direct, manage and support the Team responsible for the full lifecycle of certificates (internal and external).
• Inventory, discovery, monitoring, renewal, replacement, and revocation.
• Proactively manage processes / Team for certificate expirations to prevent service disruptions.
• Oversee troubleshooting certificate-related issues across applications, operating systems, and network devices.
• Develops the strategic IT plan enabling network services to be delivered through consistent approaches and solutions.
• Identifies opportunities to drive value for Centene through the network services strategy.
• Defines and maintains all network services key performance indicators (KPI) metrics.
• Accountable for the management of access, security, continuity, and maintenance of network services.
• Works closely with IT leadership to ensure network changes and enhancement projects are reviewed, agreed upon, and scheduled.

Manager, Network Engineering

Communications

• Create and edit video content for the health plan
• Develop and maintain repository of member and provider documents related to health plan initiatives and communications
• Conduct quality review of member and provider documents for the health plan
• Participate in additional ad-hoc duties throughout the duration of the internship period

Communications & Videography Intern – Graduate, Summer

Systems Engineer

• Responsible for managing, configuring, and supporting the Coupa Procure-to-Pay (P2P) system.
• Work closely with procurement, finance, and IT teams to optimize the Coupa system.
• Administer and configure Coupa system settings to ensure optimal performance.
• Analyze and improve existing P2P processes.
• Lead cross-functional requirements discovery with various teams.
• Design and implement Coupa solutions including reports and workflows.
• Lead integration efforts between Coupa and other enterprise systems.
• Provide end-user support and training.
• Ensure compliance with internal policies and external regulatory requirements.

Senior Coupa Financial Systems Analyst

Analyst

• Ensures the integrity, quality, and compliance of healthcare investigations through audits, process improvements, and collaboration with investigative teams.
• Combines analytical review, training, reporting, and some policy development to support organizational goals and regulatory standards.
• Conduct regular audits of Special Investigation Unit (SIU) and Compliance Investigation Unit (CIU) investigative case documentation and notes to ensure compliance.
• Assist in identification of trends, discrepancies, or potential areas of risk, providing actionable items to leadership.
• Develop and maintain audit tools, scorecards, and tracking systems.
• Collaborate with Investigative teams and leadership to address audit findings and implement remediation plans.
• Monitor implementation of process changes to ensure sustained compliance and improved quality outcomes.
• Provide feedback and support to investigative leadership on documentation requirements, best practices, and quality standards.
• Participate in training sessions to support ongoing staff education related to compliance and investigation excellence.
• Prepare audit reports and present findings to management with clear insights and recommendations.
• Track performance metrics, compliance trends, and improvement initiatives to measure program effectiveness.

Investigation Quality Audit Analyst

Manager

• Develops, assesses and coordinates holistic care management activities
• Evaluates member service needs and develops or contributes to development of care plans/service plans
• Educates members, their families and caregivers on services and benefits available
• Acts as liaison and member advocate between member/family, physician, and facilities/agencies
• Supports members with primarily mental/behavioral health needs
• Performs frequent home and/or other site visits
• Provides and/or facilitates education to long-term care members and their families/caregivers
• Provides feedback to leadership on opportunities to improve and enhance quality of care and service delivery

LTSS Service Care Manager – LCSW, LPC, Psych RN

Director

• Oversee the Provider Relations department including negotiations and administering organization policies and procedures
• Oversee the Provider Relations department to ensure in compliance with company policies and standards, government laws, regulations and contracting standards
• Develop, implement and monitor policies and procedures
• Develop tactical plans to align strategies and technologies with future needs
• Effectively manage budget and all resources for short and long-term needs
• Prepare and analyze reports on departmental and organizational activities and recommend improvements
• Ensure timely Provider set up processing, auditing and distribution of Provider Relations data management
• Create effective organizational structure and develop staff skills and competencies
• Develop and oversee the training program for the Provider Relations Department

Director, Provider Relations

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, Power BI

Project Manager

• Support enterprise-wide projects within the Medicare Operations department
• Utilize cross functional teams to deliver defined requirements and meet company strategic objectives
• Ensure projects are delivered on time, within scope, and in compliance
• Drive continuous process improvement and risk mitigation
• Lead the full project lifecycle including intake, requirements definition, planning, execution, deployment, and closure
• Develop and maintain project plans, schedules, milestones, and deliverables
• Proactively identify, manage, and escalate project risks and issues
• Partner with cross-functional stakeholders across Operations, Compliance, IT, and Business teams
• Facilitate project meetings, working sessions, and decision forums
• Maintain accurate project documentation to support transparency, auditability, governance, and operational readiness
• Track progress against defined success metrics

Medicare/DSNP Project Manager III

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
• 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
• 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

Customer Service Advocate I – Mandarin Bilingual

• Provides strategic leadership for teams performing advanced, complex claim reviews to ensure accuracy, regulatory compliance, and achievement of payment integrity goals.
• This role accelerates program growth by analyzing performance trends, standardizing processes, and implementing consistent review methodologies.
• Leveraging deep expertise in ICD-10, CPT/HCPCS coding, and clinical guidelines, the manager delivers actionable insights that shape operational strategies and drive informed decision-making.
• Monitoring and optimizing business processes to ensure accuracy, compliance, and integrity in billing and claims payment.
• Leads and mentors high-performing teams conducting advanced coding and clinical validation reviews.
• Develops and maintains standardized documentation that supports business objectives and ensures consistency in review methodologies and outcomes.
• Collaborates with cross-functional stakeholders to identify process improvement opportunities and champion innovative solutions.
• Establishes and oversees end-to-end audit program lifecycle within Payment Integrity by setting strategic audit direction, managing and developing teams, and ensuring compliance with all regulatory, contractual, and organizational requirements.

Manager, Clinical & Coding Review, DRG

• Serve as the primary point of contact and liaison between account management and specialty pharmacy operations
• Responsible for facilitating the resolution of specialty pharmacy escalated issues from the account management team's payer clients
• Investigate and provide resolution to payer concerns regarding specialty dispenses to members
• Analyze and monitor payer complaints to identify trends; develop and implement action plans to maintain high levels of quality service
• Collaborate with account management and specialty pharmacy operations departments to investigate and resolve all issues
• Expedite urgent orders and follow through to dispense
• Document and provide status updates on outstanding issues
• Monitor high risk members and prescriptions to mitigate risk
• Work with internal teams to enhance processes based on expertise and client insight
• Mentor, develop and train newly hired team members as assigned
• Performs other duties as assigned
• Complies with all policies and standards

Service Delivery Manager

Strategy

• Participate in the development of strategic business plans specific to the standalone Prescription Drug Plan business
• Coordinate and communicate the product strategy and determine key priorities, policies and procedures for product lines and programs
• Build strong cross-functional relationships with shared service partners and markets to implement business strategies
• Lead the execution and management of strategic intelligence initiatives that serve as a foundation for enterprise-wide decision-making
• Drive cross-functional efforts aligned with annual business and strategic plans by delivering intelligence-based, forward-thinking recommendations derived from market trends, competitor analysis, and internal performance metrics
• Execute and manage the implementation of strategic recommendations
• Support the strategic and business planning process and lead larger scale, cross-functional initiatives that are intended to deliver on annual business and strategic plans
• Analyze competitor data/landscape, develop competitive dashboards, provides analytical insights (e.g., expansion, new products), and provide recommendations to leadership on potential next steps
• Lead and execute complex data related analytical projects to drive business decisions and efficiencies
• Operates as a PDP subject matter expert, responsible for gathering, analyzing, and distributing strategic intelligence to empower leaders across departments with actionable guidance aligned to organizational goals

Senior Strategy Manager

• Manages the building and automation of capacity and scenario planning models to support service, quality, and efficiency standards
• Sets goals and objectives for workforce management team for achievement of operational results
• Manages all activities within the workforce management function for the contact center
• Drives and manages the innovation, planning and implementation of contact center efficiencies including allocating staffing based on analysis of schedules and work volume
• Collaborates with departments and contact center leadership to determine optimum staffing, scheduling, and resource allocation to ensure improved productivity and operational efficiency within the contact center
• Monitors work performance and analyze results to identify challenges and anticipate contact center’s future needs
• Develops strategies and identifies staffing needs for forecasted new businesses
• Leads and communicates the performance of the workforce management function of the contact center to senior leadership
• Maintains knowledge of all policies and procedures within the workforce department to ensure compliance of established procedures
• Partners with senior leadership to ensure consistent adherence to documented workflow guidelines and established procedures
• Partners with senior leadership to provide performance reviews and oversee the development and implementation of trainings
• Assists workforce management senior leadership in onboarding, hiring, and training new employees, recent promotes, and transfers within the workforce management department and provides input

Manager, Workforce Management

Actuary

• Assist in financial analysis and forecasting
• Support Medicare Fee For Service (FFS) and other expense forecasting
• Develop and run data reports to identify emerging trends and gaps
• Create financial and analytical exhibits and communicate the results to both technical and non-technical audiences
• Take ownership of project tasks and progress them with general guidance from senior staff

Senior Actuarial Analyst – Medicare

Data Analyst

• Oversee and ensure accurate, timely, and efficient reporting related to all core business functions
• Ensure the timeliness and accuracy of internal and external report deliverables
• Manage scheduled and ad hoc reporting needs of the organization
• Execute and manage the completion of large reconciliation tasks
• Responsible for the quality and completeness of data in core systems by performing and overseeing the auditing of data
• Oversee large systems and data related projects
• Mentor and manage a team of data analysts of variable skill and practice levels
• Lead and execute complex data related analytical projects to drive business decisions and efficiencies