Supervisor, Claims

Centene Corporation•Remote-MO, MO

4d•$56,200 - $101,000•Hybrid

About The Position

Centene is seeking a Supervisor, Claims to oversee the day-to-day work functions of the assigned claims area. This role provides 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. This position focuses on process improvement and cost control to ensure medical claims are processed accurately and timely, serving as a liaison between internal customers, vendors, and other stakeholders involved in the claims life cycle. Centene is a diversified, national organization focused on transforming the health of communities and offers competitive benefits and workplace flexibility.

Requirements

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
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

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