Director, Claims Business Implementation

Centene Corporation; United States; Hybrid; USD 148,000 - 274,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Flexible work arrangements

Job summary

Centene Corporation in the United States seeks a strategic leader to oversee the implementation of products and plans into Claims business units, ensuring alignment with corporate strategies, timelines, and models across new markets, reprocurements or regulatory changes.

You will direct the creation and maintenance of standard models, lead Claims and Configuration Operations during implementations, and provide input into operating models and business planning.

Qualifications

• Bachelor’s degree or equivalent; Master’s preferred.
• 7+ years of project management experience.
• 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.

Responsibilities

• 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 BRD approvals 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.

Skills

Project management

Education

Bachelor’s degree in related field or equivalent experience

Master’s degree preferred

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

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

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.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act