Regional Vice President, Claims Operations
Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members.
Position Purpose : Lead a large scale organization accountable for the accurate, timely and efficient processing of Claims.
Set the strategic vision and objectives of the claims operations to drive innovation, higher operational performance and quality outcomes.
- Set the strategic claims vision in compliance with federal, state and Company guidelines
- Leverage industry best practices, technology innovations and process redesign elements into the strategic vision of claims to support the continued organic and inorganic growth of the company.
- Direct day to day operations of the claims departments and ensure the claims are processed within established government and company guidelines.
- Empower the claims leadership team and supports the department and ensure quality claims metrics and service level agreements are met
- Collaborate with executive leadership from internal departments to ensure efficiency and proper prioritization of the claims adjudication process
- Develop production and quality standards are met and stretch goals are established to drive sustainable long-term quality and efficiency models
- Set service levels and increase real time prioritization and productivity capabilities
- Drive innovation to Establish, evaluate, and implement processes and procedures to accomplish the organization's and departments’ objectives
- Ensure compliance with all state and federal claims payment laws and guidelines
Education / Experience :
Bachelor’s degree in Business Administration, Management, or Finance; Master’s degree preferred. 10 years of experience in overseeing and developing claims operations, preferably in a managed care and / or Medicaid setting.
Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
Centene offers a comprehensive benefits package including : competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.
Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law.
Total compensation may also include additional forms of incentives.
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