Supervisor, Claims

Centene Corporation•Remote-MO, MO

1d•$56,200 - $101,000•Hybrid

About The Position

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. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT.

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.
Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT.

Nice To Haves

Strong leadership experience strongly preferred.
Claims processing experience preferred.
Experience with Medicaid, Marketplace and/or Medicare preferred.

Responsibilities

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