Supervisor, Claims

Centene Corporation

1d•Remote

About The Position

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Applicants for this job have the flexibility to work remote from home anywhere in the United States Position Purpose: Oversee the day-to-day work functions of the assigned claims area, provide technical and leadership support to staff to resolve complex issues. The Supervisor will develop and implement policies and procedures that comply with state and federal regulations. Process improvement, cost control to process medical claims accurately and timely and serve as a liaison between internal customers, vendors and other stakeholders involved in the claims life cycle. Provide oversight and support to ensure that Claims inventory is managed accurately, timely and within compliance - internal and regulatory requirements. Prioritize work volumes daily through reporting, load balancing, and managing operational overtime cost. Help to identify opportunities for improvements and resolve operational gaps/problems with a financial, regulatory, cost/benefit and stakeholder experience. Assist in reviewing, investigating, adjusting, and resolving all pending claims, especially complex claims. Serve as a point of escalation for these matters. Monitor claims quality reviews for accuracy, document results and identify trends and systemic root cause analysis. Point of contact for the team, for the plan and for other departments in researching, collecting background information and documentation and to address various issues. Responsible for preparing reporting, analysis and insights that is consistent with defined standards to drive operational excellence. Maintain appropriate records, files, documentation, etc. Special Project work as assigned. Facilitate change to support current and future business needs. Performs other duties as assigned. Complies with all policies and standards.

Requirements

Associate degree in related field or equivalent experience required.
2+ years of health insurance industry, claims processing, physician’s office or other office services experience required.
Previous experience in a supervisory/lead role with defined outcomes required.

Nice To Haves

Experience with Medicaid, Marketplace and/or Medicare preferred.

Responsibilities

Oversee the day-to-day work functions of the assigned claims area
Provide technical and leadership support to staff to resolve complex issues
Develop and implement policies and procedures that comply with state and federal regulations
Process improvement, cost control to process medical claims accurately and timely and serve as a liaison between internal customers, vendors and other stakeholders involved in the claims life cycle
Provide oversight and support to ensure that Claims inventory is managed accurately, timely and within compliance - internal and regulatory requirements
Prioritize work volumes daily through reporting, load balancing, and managing operational overtime cost
Help to identify opportunities for improvements and resolve operational gaps/problems with a financial, regulatory, cost/benefit and stakeholder experience
Assist in reviewing, investigating, adjusting, and resolving all pending claims, especially complex claims
Serve as a point of escalation for these matters
Monitor claims quality reviews for accuracy, document results and identify trends and systemic root cause analysis
Point of contact for the team, for the plan and for other departments in researching, collecting background information and documentation and to address various issues
Responsible for preparing reporting, analysis and insights that is consistent with defined standards to drive operational excellence
Maintain appropriate records, files, documentation, etc
Special Project work as assigned
Facilitate change to support current and future business needs
Performs other duties as assigned
Complies with all policies and standards