Manager, Claims & Contract Support Services

Peach State Health Plan; Atlanta (GA); Remote; USD 86,000 - 155,000; Full time

Job summary

An established industry player is seeking a Manager for Claims & Contract Support Services to oversee operations and ensure quality in claims processing. This role involves managing teams, monitoring performance, and implementing business solutions to enhance efficiency. With a focus on provider relations and claims administration, you'll play a crucial role in the health plan's workflow and contract implementation. The company offers a flexible work environment with options for remote or hybrid schedules, along with a competitive benefits package tailored to support your career growth and work-life balance. If you're passionate about making a difference in healthcare, this opportunity is for you.

Benefits

Health insurance

401K

Stock purchase plans

Tuition reimbursement

Paid time off

Flexible work schedules

Qualifications

• 5+ years of experience in provider relations/services or claims administration.
• Bachelor's degree or equivalent experience required.

Responsibilities

• Oversee claims operation and monitor staff performance.
• Act as subject matter expert in claims and configuration issues.
• Interface with all organizational levels to ensure accurate operations.

Skills

Provider relations/services

Claims administration

Contracting

Data analysis

Problem-solving

Education

Bachelor's degree in related field

Equivalent experience

Job description

Manager, Claims & Contract Support Services

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

• Applicants for the job have the flexibility to work remote from home anywhere in the United States.

Position Purpose

Oversee the operation of the Contract Implementation Analyst and Claims Liaison teams.

• Oversee the claims operation function, including contracting and configuration.
• Monitor staff performance to identify any process or quality gaps and develop/implement business solutions to correct issues.
• Provide management with necessary data to expedite resolution of claims issues and support in policy decisions related to claims operations.
• Serve as the subject matter expert in resolution of claims and configuration issues.
• Manage the health plan’s workflow to assure timely, accurate submission and implementation of contracts.
• Act as health plan interface on software product upgrades/implementations that affect contract implementation.
• Promote change through establishment and sharing of best practices.
• Interface with all organizational levels to mobilize commitment and ensure accurate configuration, contract implementation, and claims operations.

Education/Experience

Bachelor’s degree in related field or equivalent experience. 5+ years of provider relations/services, provider contracting and/or claims administration experience in a managed care environment. Experience with Medicare and Medicaid claims and contracting preferred.

Pay Range: $86,000.00 - $154,700.00 per year

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. Total compensation may also include additional forms of incentives.

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.

Seniority level

Not Applicable

Employment type

Full-time

Job function

Finance and Sales

Industries

Hospitals and Health Care and Insurance