Centene Corporation

Human Resources

• Provides leadership and operational oversight for the Human Resources (HR) Compliance Program
• Accountable for the design, execution, governance, and continuous improvement of HR compliance strategies
• Partners closely with HR, Legal, Compliance, and business leaders to proactively identify, mitigate, and manage employment related risk
• Leads the governance of the HR Compliance Program, overseeing policy lifecycle management, compliance monitoring frameworks, risk prioritization, and control effectiveness
• Develops, implements, and maintains HR compliance policies, procedures, and controls aligned with federal, state, and local employment laws and regulations
• Establishes and oversees HR compliance monitoring activities, audits, and assessments to identify trends, gaps, and emerging risks
• Oversees internal and external audit responses related to HR compliance, including documentation preparation, cross functional coordination, and remediation tracking
• Ensures timely and accurate completion of required regulatory reporting, employee notices, and employment related compliance obligations
• Provides direct oversight of the Centene Immigration Program, including program governance, vendor management, escalation of complex case issues, and compliance with immigration related regulatory requirements
• Leads and influences HR, Legal, and business leaders to evaluate employment practices and ensure consistent and compliant execution across the organization
• Serves as a subject matter expert on HR compliance risk areas and regulatory requirements
• Provides risk based guidance and recommendations related to HR compliance matters
• Sets strategy and standards for HR compliance communications and training initiatives for the People Team
• Analyzes compliance trends and metrics and partners with People Team leadership to drive proactive, risk mitigating process and program improvements
• Manages and provides governance oversight of external vendors supporting HR compliance programs

Manager, Human Resources Compliance

Operations

• Lead enterprise-wide, cross-functional process improvement initiatives from problem definition through implementation and sustainment.
• Prioritize and lead process improvement activities across the enterprise in support of all departments and functional areas.
• Facilitate workshops and working sessions including process mapping, root cause analysis, future-state design, and prioritization exercises.
• Apply Lean, Six Sigma, and continuous improvement methodologies to improve operational performance, reduce variation, and eliminate waste.
• Partner with senior leaders to identify high-impact improvement opportunities aligned to strategic objectives.
• Translate complex operational challenges into structured improvement roadmaps with clear milestones and success metrics.
• Leverage data and analytics to quantify problems, validate root causes, and track benefits realization.
• Develop business cases and executive-level presentations to communicate insights, recommendations, and outcomes.
• Coach and mentor business partners and junior team members on continuous improvement tools and ways of working.
• Provide training and guidance to project teams and functional areas to assist with the implementation and maintenance of process improvement activities.
• Collaborate with Technology, Product, Compliance, and Operations teams to ensure solutions are scalable, compliant, and sustainable.
• Support the development of standard work, governance models, and performance management routines to embed improvements.
• Evaluate completed process improvement projects to identify and implement best practices and lessons learned.
• Provide leadership and oversight of the business unit's implementation processes; managing company adherence to standard implementation processes.
• Manage business and program implementations to meet budget, timeline, and contractual requirements.
• Maintain standard business implementation organizational structures, team structures, work breakdown structures, work planning, issue logs, decision logs, change control and executive reports.
• Provide input on operating models, including standard corporate functional and information system models, performance metrics, expected outcomes and plan impacts.
• Coordinate cross-functional tasks between various internal and external areas to ensure successful project outcomes.
• Communicate project status to all internal and external stakeholders.

Director, Process Improvement

Director

• Oversee the product development and management of health and wellness products for the Medicaid (and other government programs) market
• Design, develop, implement, and manage new and existing products from initial conception through service delivery
• Monitor market trends to identify new product opportunities or enhancements to existing products
• Review product performance and outcomes and make recommendations for program improvements
• Respond to product inquiries and assess new product requests
• Participate in the development of business strategy for the Medicaid market
• Ensures legal and regulatory compliance of new products and product enhancements
• Establish standard processes and reporting

Director, Product Development – Management, Medicaid

Chief Operating Officer

• Oversee operations for multiple support functions
• Develop operational vision, objectives and policies and procedures
• Ensure cost effective, client-responsive programs are developed and maintained
• Identify operational efficiencies and meet regulatory and client expectations
• Responsible for achieving business unit financial targets

Manager

• Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends and schemes
• Monitor business processes and systems to assure integrity and compliance in billing and claims payment
• Lead a team appropriately investigate all possible fraud, waste and abuse referrals
• Develop educational materials to address/identify waste activities as requested by the health plan and on an ad-hoc basis
• Attend state/federal meetings as required by specific contracts
• Review pre-payment cases with appropriate parties for the purposes of developing resolution strategies
• Prepare and distribute monthly and quarterly saving reports
• Participate in Appeals Committee, work groups and interdepartmental meetings

Manager, SIU Prepay Investigations

Analyst

• Leads the design implementation, deployment, and support of engineering platforms
• Ensures that standards, policies, and procedures are well defined and embedded throughout the technical platform function
• Acts as technical ambassador for platform management function
• Drives innovation by promoting the adoption of platform services best practices and modern software engineering principles
• Responsible for establishing and implementing platform environment roadmap for all application changes across platform
• Sets the standards for platform administration and ensures that procedures exist for all routine platform administration activities
• Works with technical and solution architects to ensure alignment with overall platform roadmap
• Supports head of platform function in developing strategy for platform services
• Provides technical skills to fix complex platform incidents or problems that have been escalated from operations team
• Promotes use of platform services best practices and modern software engineering principles
• Ensures key platform related processes are well documented and aligned with recognized industry best practice models
• Carries out platform market analysis to identify and drive strategic productivity improvements
• Manages key suppliers with relation to complex platform technical problems
• Identifies and ensures management and mitigation of platform related risks
• Supports business units in resolution of in-depth user questions and issues
• Identifies effective solutions for business platform issues
• Maintains working knowledge of new technology and business analysis standards & practices
• Collaborates with IT management to define and develop documentation & business analysis artifact standards, guidelines, processes, and templates
• Performs other duties as assigned

Lead Business Platform Analyst

Customer Support

• Assisting members and clients at an assigned Fidelis Care office location
• Meeting daily performance standards and customer service standards
• Logging every interaction into Salesforce
• Complying with all NYSOH Marketing Guidelines
• Clarifying customer complaints and resolving issues
• Developing and maintaining relationships with existing members
• Performing duties of higher rated positions for developmental purposes

Customer Care Associate

Account Manager

• Responsible for working with regional and corporate personnel to identify, build and implement business strategies that support HN's provider network and product development initiatives
• Works closely with other departments to facilitate process improvement and other strategic initiatives
• Directs and supervises staff in the development and implementation of Strategic Provider Partnership Initiatives
• Develops, recommends and implements cross-functional plans and activities to achieve strategic initiatives; communicates insights, progress of challenges and presents resolution scenarios
• Tracks/reports status on strategic partnerships, risk adjustment, tailored network development and other activities to leadership teams
• Builds and maintains effective working relationships with cross-functional leaders and teams in order to identify, explore, present and implement business opportunities
• Maintains a service-oriented atmosphere within the Network Management department
• Ensures that team’s activities and business operations are carried out in compliance with company policies, and local, state and federal regulations and internal requirements
• Responsible for associates’ work climate and provides leadership for initiatives to make the department a great place to work

Vice President – Strategic Provider Partnerships

• Responsible for developing, implementing, monitoring and measuring performance of strategic initiatives aimed at enhancing quality of care, improving health outcomes, and achieving savings through reduction of inappropriate utilization
• Drive value creation efforts by ensuring efficient and effective program implementation as well as optimal reporting and analysis capabilities to track and trend performance, automate activities, and identify new population health management opportunities
• Manage portfolio of initiatives aimed at creating value in areas of medical management
• Collaborate with Senior and Executive leadership in the identification of high-value performance improvement opportunities within Clinical Operations aimed at improving member health outcomes, increasing quality of care and member satisfaction, and reducing inappropriate utilization / medical spend
• Direct a team responsible for innovation, performance improvement, and performance measurement

Director, Healthcare Transformation

• Manages the correspondence and/or appeals, disputes, and reconsiderations process
• Manages issues and provides guidance on the review and timely processing
• Maintains expert knowledge of contract requirements, policies, procedures, and performance standards
• Ensures team’s compliance with contract requirements, policies, and procedures
• Reviews reporting and analyzes activities to identify trends and provides recommendations
• Provides expert knowledge, guidance and education to team based on experience
• Works with team and leadership to identify opportunities for process and quality improvement
• Assists with onboarding, hiring, and training
• Leads and champions change within scope of responsibility

Manager, Behavioral Health Appeals

• Oversee network management activities including network development, provider relations, and provider data analytics within an assigned market.
• Develop, implement, evaluate, and improve operational models aligned with strategic initiatives and compliant with accreditation, legislative and regulatory requirements.
• Responsible for overseeing the development of reports to support quality member outcomes, provider recruitment, provider retention, and contracting initiatives.
• Develop and drive uniformity, efficiencies and consistencies within Provider Network Management promoting Manage daily activities of staff, including network development, provider relations, and provider data analytics.
• Oversee quality assurance processes and reporting to ensure compliance with accreditation, federal and state regulatory requirements including access and availability and demographic reporting related to providers.
• Establish and maintain strong relationships with other divisions to ensure that provider network management activities are linked appropriately to other applicable areas of the organization.
• Implement and manage development of documented provider network management policies and procedures.
• Oversee quality audits and compliance reporting across all areas of provider network management.
• Develop education and communication plans for internal staff and providers.
• Facilitate and assist with problem resolution for internal provider network management issues but also for broader scope issues that impact provider network management including but not limited to providers, claims, customer contact center, medical management, and appeals and grievances.
• Perform management duties including budgeting, performance management, staff development, training, staffing, and establishing department goals and objectives.

Senior Manager, Provider Network Management Operations

Systems Engineer

• Drives the collaboration with business and IT stakeholders to translate complex business requirements into comprehensive functional and non-functional technical specifications
• Leads Power BI adoption and utilization across the team
• Gathers and validates business/technology requirements
• Analyzes and verifies requirements for completeness, consistency, comprehensibility
• Creates systems and business process models, specifications, diagrams, and charts
• Communicates changes, enhancements, and modifications of business requirements

Senior Business Systems Analyst – Power BI

Accounting Manager

• Allocate payments, reconcile and audit assigned individual and employer group accounts
• Allocates routine employer group payments and reviews unapplied cash report for guidance
• Applies payments, reviews unapplied cash, research basic billing or membership discrepancies, and respond to rate and billing inquiries
• Assists senior staff with exceptions and account issues
• Works with Eligibility Representatives to maintain accurate and timely membership and financial records

Membership Accounting Representative – Group Enrollment

Program Manager

• Plan, organize, monitor, and oversee programs utilizing cross functional teams
• Support business department initiatives that promote quality, safety and cost of care opportunity
• Responsible for gathering requirements, creating plans and schedules, managing resources, and facilitate project execution and deployment
• Maintain detailed business process documentation including meeting minutes, action items, issues lists and risk management plans as applicable
• Communicate program status to management and key stakeholders
• Identify requirements, procedures and problems to improve existing processes
• Manage projects through the full project life cycle
• Provide leadership and effectively communicate project status to all stakeholders

Program Manager II – Government and Community Relations

• Manages the day-to-day responsibilities of a team focused on creating Enterprise-class data assets reports, visualizations, dashboards, and metrics
• Supports the delivery of meaningful quantitative or qualitative analyses addressing impactful business issues or questions
• Partners with stakeholders to identify business requirements, prioritize requirements based on resources (budget/timeline) and manage the end-to-end design and development of solutions
• Ensures policies, practices, and procedures are understood and followed by the team, clients, and stakeholders
• Develops and/or refines procedures to improve results and leads change efforts to ensure sustainable improvement
• Designs, develops, implements, and trains end-users on new BI and Analytical Solutions