Vice President, Claims Configuration Operations (Health Plan)

Centene Corporation

4d

About The Position

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: Oversee business operations, procurement opportunities, new product implementations and complex initiatives for business development utilizing cross-functional business units and corporate teams to meet business unit and corporate strategic objectives. Partner with multiple stakeholders and leadership to establish strategic visions, operational objectives, and policies and procedures ensuring compliance with state contracts, related laws, regulations and executive orders. Monitor and report achievement of committed action plans to senior management. Direct the development and implementation of operational work processes and systems with direct oversight for multiple departments within the business unit. Accountable for budget, revenue targets, and Profit & Loss. Lead and oversee new business implementation and procurement activities for all products and complex projects, including RFP responses. Evaluate program opportunities and recommendations for effectiveness and ROI. Perform duties as senior liaison between the business unit, corporate, and external stakeholders. Oversee preliminary discovery, due diligence for potential liabilities, internal control weaknesses, and financial integrity. For Acaria Health Specialty Pharmacy, substitution of a PharmD coupled with 9+ years of experience is acceptable. Role will oversee pharmacy fulfillment operations and case management. Establish and maintain operational strategic vision for our specialty operations.

Requirements

• Bachelor's Degree in Business Administration, Finance, Accountancy or a related field required.
• 9+ years of operations, management, or administration in the Healthcare or Insurance industry experience required.
• For Acaria Health Specialty Pharmacy, substitution of a PharmD coupled with 9+ years of experience is acceptable.

Nice To Haves

• Master's Degree preferred.
• Experience in business development and/or Request for Proposal (RFP) preferred.
• Extensive knowledge of state legislative and regulatory processes preferred.

Responsibilities

• Oversee business operations, procurement opportunities, new product implementations and complex initiatives for business development utilizing cross-functional business units and corporate teams to meet business unit and corporate strategic objectives.
• Partner with multiple stakeholders and leadership to establish strategic visions, operational objectives, and policies and procedures ensuring compliance with state contracts, related laws, regulations and executive orders.
• Monitor and report achievement of committed action plans to senior management.
• Direct the development and implementation of operational work processes and systems with direct oversight for multiple departments within the business unit.
• Accountable for budget, revenue targets, and Profit & Loss.
• Lead and oversee new business implementation and procurement activities for all products and complex projects, including RFP responses.
• Evaluate program opportunities and recommendations for effectiveness and ROI.
• Perform duties as senior liaison between the business unit, corporate, and external stakeholders.
• Oversee preliminary discovery, due diligence for potential liabilities, internal control weaknesses, and financial integrity.
• Establish and maintain operational strategic vision for our specialty operations.

Benefits

• 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, including full-time or part-time status.
• Total compensation may also include additional forms of incentives.
• Benefits may be subject to program eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Executive
• Number of Employees: 5,001-10,000 employees