Centene Corporation

Operations

• Oversee operations and business strategy using cross-functional departments to meet strategic objectives
• Develop and manage methodologies for tracking, identifying, and solving issues
• Interpret and present program results and insights
• Develop data-driven analysis approaches for clients
• Perform data analysis from varied data sources
• Evolve metrics measuring effectiveness and return on investment of product activity
• Collaborate with staff to identify internal and external customers and their expectations
• Initiate process changes to increase quality, decrease costs, and improve staff, provider, and member satisfaction
• Facilitate and support operations staff in planning, achieving, and tracking key strategic initiatives
• Serve as an internal resource and advisor on improvement activities
• Explore new work-process approaches using quality-improvement techniques to eliminate waste and re-work

Operations Manager

Program Manager

• Develop strategies to realize improvement opportunities and ensure organizational prioritization and resource alignment
• Manage multiple projects through the full project life cycle
• Gather requirements and create project plans and schedules
• Obtain and manage resources and budgets
• Facilitate project execution, deployment, and closure
• Use project management tools and techniques
• Maintain project documentation, action items, issue lists, and risk mitigation plans
• Communicate project status to stakeholders through executive summaries and presentations
• Negotiate with stakeholders to secure resources, resolve issues, and mitigate risks
• Lead cross-functional meetings
• Provide functional and technical knowledge regarding program requirements and operations

HR Program Manager – III

Business Operations

• Lead business case development for proposed initiatives, assessing opportunities, risks, and return on investment
• Support strategic and business planning, including initiative input, prioritization, and alignment with business objectives
• Transition approved business cases into initiatives with documentation and clear responsibilities
• Lead large-scale, cross-functional initiatives focused on performance improvement, financial gains, customer satisfaction, and compliance
• Provide strategic and policy guidance to maximize effective implementation and results
• Organize work teams, establish project plans, facilitate meetings, build consensus, document recommendations, and oversee implementation
• Analyze data, workflows, policies, procedures, staff organization, and skills
• Use project management software including Excel, PowerPoint, Visio, and Microsoft Project
• Lead staff responsible for initiatives in the company operating plan and support their development and completion
• Assist project leaders with facilitation, analysis, process mapping, brainstorming, and project management issues
• Write and deliver communications across the organization about process improvement initiatives
• Provide related support to improve business performance
• Perform other duties as assigned
• Comply with all policies and standards

Senior Business Process Consultant

Care Coordinator

• Assist in developing, assessing, and coordinating holistic care management activities
• Develop or assist with personalized service care plans for long-term care members
• Educate members and families/caregivers on available services and benefits
• Evaluate member needs and available resources and recommend or facilitate care plans
• Assist with ongoing long-term care plans and identify providers, specialists, and community resources
• Coordinate between members/families/caregivers and care provider teams
• Provide resource support for employment, housing, participant direction, independent living, justice, and foster care needs
• Monitor care plans, member status, and outcomes and recommend updates
• Interact with long-term care healthcare providers and partners
• Collect, document, and maintain member information and care management activities for regulatory compliance
• May perform on-site visits to assess member needs and collaborate with providers or resources
• Provide or facilitate education on procedures, healthcare provider instructions, service options, referrals, and healthcare benefits
• Provide leadership feedback on opportunities to improve quality of care and cost-effective service delivery
• Perform other duties as assigned

LTSS Service Care Coordinator

Actuary

• Assist in financial analysis, pricing, and risk assessment to estimate outcomes
• Support business decision-making through actuarial analysis, healthcare cost trend evaluation, and identification of savings opportunities across healthcare data sources
• Connect eligibility, revenue, claims, provider, and other healthcare data sources to identify and quantify savings opportunities
• Communicate findings and recommendations to project leadership and key stakeholders
• Work with large relational datasets and varying levels of data granularity to consolidate and prepare key input data
• Build actuarial models with clear, flexible assumption inputs and summarized outputs
• Apply mathematics, probability, statistics, finance, and business principles to calculate financial outcomes
• Assist with developing probability tables from statistical analysis and pertinent information
• Analyze and evaluate required premium rates
• Assess cash reserves and liabilities for future benefit payments
• Develop and run data reports
• Assist with determining an equitable basis for distributing insurance benefit funds
• Participate in merger and acquisition analysis
• Perform other duties as assigned
• Comply with all policies and standards

Senior Actuarial Analyst

General

• Identify, negotiate and manage high performing provider and vendor partnerships
• Lead complex provider negotiations
• Strengthen strategic partnerships
• Support affordability and network adequacy goals
• Serve as a senior contracting expert
• Negotiate vendor or provider contracts and manage implementations and ongoing relationships
• Perform market research and analysis
• Define, initiate and direct financial analyses and operational reporting for assigned vendor and provider agreements
• Lead, manage and track ongoing financial and operational success of designated partnerships
• Develop and initiate corrective action plans or agreement modifications when necessary
• Coordinate with local health plans and applicable internal teams
• Lead meetings with health plans and corporate teams, including executive management, to review agreement performance data, scorecards and partnership strategy

Contract Negotiator V

Security Engineer

• Operate, maintain, and continuously improve enterprise data security technologies
• Administer advanced functions in all Data Security systems
• Independently troubleshoot Data Security systems
• Perform system upgrades according to Change Management procedures
• Implement new capabilities and functionality
• Document new systems and tools
• Drive operational improvements that strengthen the organization's data security posture
• Comply with all policies and standards
• Perform other duties as assigned

Data Security Engineer II

Psychologist

• Authorize, direct, and monitor care for behavioral health and/or substance abuse problems according to clinical information and internal medical-necessity criteria
• Conduct peer reviews with psychologists, behavioral health therapists, and/or Board Certified Behavior Analysts for outpatient services and psychological testing requests
• Interact with network practitioners to provide education on best-practice models and utilization-management processes
• Discuss clinical authorization questions and concerns with the Medical Director or designee
• Respond to state, provider, and member complaints related to psychological testing or other services requiring PhD/PsyD review
• Facilitate outpatient rounds, providing clinical input and oversight
• Perform other duties as assigned
• Comply with all policies and standards

Psychologist Reviewer

Representative

• Retain current membership by assisting members with completion and processing of Government health program applications
• Respond to inquiries from new and existing members regarding the application process
• Meet daily production metrics designed to achieve higher membership retention
• Research, analyze, and document inquiries regarding program eligibility
• Answer application and service questions regarding programs and services
• Conduct follow-up calls reminding members to return recertification applications
• Request missing documentation when warranted
• Develop and maintain relationships with existing members through the recertification process
• Provide guidance, education, and assistance to promote the value and benefits offered by the Plan
• Modify delivery skills to overcome objections and retain members
• Identify solutions to issues and concerns
• Complete required paperwork and documentation for the application process
• Track and input recertification actions to ensure member accounts reflect activities performed
• Input, update, and create member information in databases
• Utilize computer systems for administrative functions
• Perform other duties as assigned
• Comply with all policies and standards

Retention Representative

• Operate and mature Centene’s Attack Surface Management and Breach Attack Simulation programs across hybrid, cloud, on-premises, and enterprise environments
• Validate internet-facing assets, confirm ownership, assess security coverage, and maintain inventory accuracy
• Coordinate remediation activities and execute breach attack simulation exercises
• Validate control effectiveness and produce actionable reporting
• Partner across security, infrastructure, cloud, application, risk, compliance, and business teams
• Implement and maintain application security standards according to industry best practices
• Analyze application security architecture to detect deficiencies and recommend improvements
• Audit application security and operational configurations
• Monitor and remediate application security alerts and vulnerabilities
• Create application security documents and standard operating procedures, report findings, and track them to closure
• Automate routine application security operational tasks and design self-service options
• Implement authentication, authorization, encryption, logging, and application security testing throughout the SSDLC
• Review application security configurations and generate recommendations
• Comply with all policies and standards
• Perform other duties as assigned

Senior Infrastructure Security Engineer

Collector

• Perform all activities related to collections
• Verify insurance eligibility for services provided
• Verify insurance eligibility for accounts with questionable status or billing addresses
• Perform price negotiations and discounts related to collections
• Identify patient resources pertaining to reimbursement
• Inform patients of financial responsibilities stated by insurance companies
• Review and audit accounts from aging reports for missing payments
• Collect reimbursement for billed and aged accounts
• Process daily correspondence to successfully appeal third-party carriers
• Document pertinent communication with patients, physicians, and insurance companies related to collection procedures
• Submit adjustments to the accounts receivable register
• Correct errors and reimbursements for accounts and resolve billing issues

Artificial Intelligence

• Learn about various processes and functions within the Managed Care industry
• Contribute to projects that support the business
• Explore various career opportunities within the Managed Care industry
• Apply academic knowledge and learn new skills through project contributions
• Communicate project status and results to staff mentors and management
• Research legal, regulatory, and other topics within the functional area and industry
• Attend training and development presentations
• Research AI-enabled tools, automation, and learning-design practices
• Analyze workflows and baseline data
• Design and pilot process improvements
• Gather stakeholder feedback
• Create job aids, training materials, and supporting documentation
• Support related design, quality, and project activities
• Present outcomes and recommendations to leadership
• Perform other duties as assigned
• Comply with all policies and standards

Curriculum Designer Intern – Learning Design with AI and Emerging Technologies

• Serve as a partner and advisor between enterprise stakeholders and Enterprise Privacy & Security Risk Management (EPSRM)
• Translate privacy, security, AI, business continuity, regulatory, and contractual requirements into operational controls, processes, governance activities, and actionable guidance
• Partner with Health Plans, Health Care Enterprises, Shared Services, Compliance, and Market Technology Leads
• Conduct impact analyses on new requirements and facilitate cross-functional working groups
• Identify resource needs and drive complex enterprise-wide initiatives supporting audit-ready compliance
• Identify, assess, and facilitate solutions for privacy, security, AI, business continuity, risk, control gaps, and compliance issues
• Support regulatory audits, assessments, readiness reviews, compliance evidence validation, and control-effectiveness reviews
• Support market expansion, contract renewals, RFP responses, tabletop exercises, and operational readiness activities
• Partner with Legal, Procurement, business stakeholders, Government Affairs, and regulatory stakeholders
• Maintain knowledge of Centene’s business operations, technology ecosystems, vendors, and supporting processes
• Establish and maintain RACIs, decision frameworks, reporting mechanisms, project tracking, and executive communications
• Monitor industry, regulatory, and enforcement trends through professional associations, regulatory forums, roundtables, ISACs, and requests-for-comment activities
• Drive continuous improvement of Enterprise Engagement practices
• Perform other duties as assigned and comply with all policies and standards

Privacy & Security Enterprise Engagement Officer

Manager

• Develop, assess and coordinate holistic care management activities for the Population Health LTSS Care Management team and SED Waiver program
• Evaluate complex, high-risk members with mental/behavioral health needs and recommend plans of care
• Develop or contribute to care plans and service plans
• Act as liaison and member advocate between members/families, physicians, facilities and agencies
• Perform frequent home and/or site visits, once a month or more, to assess needs and collaborate with resources
• Educate members, families and caregivers about preventive care, treatment options, referrals, medications, procedures, provider instructions and healthcare benefits
• Provide subject matter expertise and operational support for behavioral health activities, including crisis calls, mental health first aid training, field safety, de-escalation practices and medication monitoring
• Educate on and coordinate medical, behavioral and social community resources
• Coordinate service authorizations for services such as meals, employment, housing, foster care, transportation and activities of daily living
• Coordinate referrals and help identify accessible providers, specialists and community resources
• Maintain accurate documentation in the electronic care management system and support compliance with clinical, state and federal guidelines
• Provide leadership feedback on opportunities to improve quality of care and cost-effective service delivery
• Perform other assigned duties and comply with all policies and standards

LTSS Service Care Manager – Behavioral Health

• Develop, implement and manage strategic fraud, waste and abuse activities
• Maintain state and federal requirements and monitor trends and schemes
• Monitor business processes and systems to assure integrity and compliance in billing and claims payment
• Lead a team to appropriately investigate all possible fraud, waste and abuse referrals
• Develop educational materials to address and identify waste activities
• Attend state and federal meetings as required by specific contracts
• Review post-payment cases with appropriate parties to obtain refunds
• Prepare and distribute monthly and quarterly savings reports
• Participate in Appeals Committee, work groups and interdepartmental meetings