Senior Manager, Claims Quality Improvement

Centene Corporation•Remote-MO, MO

5d•$107,700 - $199,300•Hybrid

About The Position

Centene is seeking a Senior Manager, Claim Quality Improvement to lead high-impact quality initiatives across a complex claims operation. This leader will leverage data, technology, and automation to improve performance, strengthen controls, and drive measurable results while leading large teams through operational excellence and continuous improvement. The position provides leadership and direction for continuous quality improvement (QI) initiatives to improve efficiency, processes and demonstrate improved quality. It also involves providing and analyzing reports to identify trends, opportunities and recommend initiatives aimed at improving quality of care and services provided by the organization.

Requirements

Bachelor’s degree in Business, Healthcare, or related field.
5+ years of quality management experience or equivalent leadership experience.
Previous experience as lead in functional area, managing cross functional teams on large scale projects or supervisory experience which includes hiring, training, assigning work and managing the performance of staff.
Deep expertise in claims operations, payment accuracy, audit methodologies, quality management systems, regulatory requirements, and operational controls to identify risks, drive quality improvements, and ensure consistent business outcomes.
Strong analytical and problem solving skills with the ability to leverage data, root cause analysis, statistical methods, and Lean/Six Sigma principles to identify trends, address performance gaps, improve processes, and deliver measurable quality and financial results.
Ability to lead large-scale quality initiatives while maintaining a practical understanding of business systems, automation, reporting tools, and emerging AI capabilities to strengthen controls, improve productivity, and scale operations efficiently.

Nice To Haves

Master's degree preferred.

Responsibilities

Provide leadership and direction for continuous quality improvement (QI) initiatives to improve efficiency, processes and demonstrate improved quality.
Provide and analyze reports to identify trends, opportunities and recommend initiatives aimed at improving quality of care and services provided by the organization.
Oversee accreditation process, specifically as it pertains to National Committee for Quality Assurance (NCQA) Accreditation and compliance with contractual requirements.
Responsible for overall coordination of company-wide quality assessment and improvement activities.
Oversee and coordinate with Corporate on annual file audits and other quality related initiatives to include those of a contractual nature.
Manage and implement appropriate work tools/processes, reports and audit tools to ensure control of key processes and program characteristics.
Recommend quality improvement opportunities based on findings and participation in developing and implementing solutions to management and the Quality Improvement Committee (QIC) and other committees, as appropriate.
Provide feedback to rectify errors and to prevent further inconsistencies.
Oversee monthly and quarterly reports and data to identify trends, opportunities for improvement and interventions.
Responsible for policies, operating procedures, and aligning goals in compliance with internal and external guidelines.