Director, Claims Business Implementation

Centene Corp.; Northern (KY); Hybrid; USD 148,000 - 274,000; Full time

Job summary

Centene Corp. is seeking a senior leader to oversee the implementation of health plan products into Claims operations in the United States. You will ensure alignment with strategy, standardize the implementation processes, and manage regulatory and contract changes across new markets.

You will direct BRD approvals, help shape operating models, ensure budgets and timelines are met, and provide strategic guidance for New Health Plan Implementations.

Qualifications

• Bachelor's degree or equivalent experience.
• 7+ years of project management experience.
• 5+ years of Government Programs Managed Care experience.
• Medicaid Managed Care experience preferred.
• Experience with BRD approvals and regulatory changes.

Responsibilities

• Oversee the implementation of products/plans into Claims units.
• Direct creation and maintenance of standard claims models.
• Provide strategic leadership of claims implementations.
• Ensure adherence to standard processes and BRD approvals.
• Contribute to operating models, performance metrics and plan impacts.
• Direct implementations to meet budget, timeline and scope.
• Develop timelines for new health plan implementations.

Skills

Project management

Leadership

Government programs

Claims implementation

Budget management

Timeline management

Education

Bachelor's degree

Master's degree

Job description

**Position Purpose -** Oversee the implementation of products/plans into Claims business units, ensuring alignment with strategies and goals and consistency in implementation processes, methodology, and models, which could include new markets, reprocurements or expansions, as well as regulatory and contract changes.* Direct the creation and maintenance of standard models for the claims implementation approach.* Responsible for all Claims and Configuration Operations functions during implementation phase.* Provide strategic leadership and oversight of the claims business implementation processes; managing company adherence to standard implementation processes, including decision authority on Business Requirements Document (BRD) approvals in collaboration with Claims Process Owner.* Provide input into operating models; standard corporate functional and information system models, performance metrics, expected outcomes and plan impacts, as appropriate.* Direct claims business implementations to meet budget, timeline and scope requirements.* Provide input into the business planning process and develop timelines for New Health Plan Business Implementations.**Education/Experience:** Bachelor's degree in related field or equivalent experience. Master's degree preferred. 7+ years of project management experience, including detailed understanding and experience applying project management methodologies and tools. 5+ years of Government Programs Managed Care experience in multiple areas of Operations (Claims, Provider/Mbr Services/Medical Management/ Network, etc). Medicaid Managed Care experience preferred.Pay Range: $148,000.00 - $274,200.00 per year