Manager, Claims Research & Analysis

centene; Town of Florida (NY); Remote; USD 108,000 - 199,000; Full time

Job summary

Centene is seeking a remote Claims Analysis Manager to guide a team of Claims Business Analysts and drive data-driven improvements in claims operations.

The role requires a Bachelor's degree and 5+ years in health plan operations, with Medicare/Medicaid experience preferred. You will mentor staff, analyze data, manage cross-functional projects, and promote standardized processes and automation while ensuring performance targets are met.

Qualifications

• Bachelor's degree required; 5+ years in health plan operations.
• Experience leading cross-functional teams on large-scale projects.
• Strong analytical and problem-solving skills.

Responsibilities

• Mentor and lead Claims Business Analysts.
• Collect, validate and analyze data to deliver business solutions.
• Monitor performance and implement solutions to address process/quality gaps.
• Use project management to work with cross-functional teams on delivery of solutions.
• Promote change through sharing of best practices.

Skills

Data analysis

Team leadership

Process improvement

Project management

Root cause analysis

Education

Bachelor's degree in related field

Job description

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Position Purpose

Manage and support claims analysis and research. Provide analytical information that identifies process improvement and root cause analysis of issues. Develop and implement solutions to improve overall delivery of claims operations. Ensure claims operation is able to meet or exceed performance measures.

Applicants for this job have the flexibility to work remote from home and must reside in Florida.

• Manage and mentor Claims Business Analysts.

• Collect, validate and analyze data to deliver business solutions.

• Monitor performance and develop & implement business solutions to address process and/or quality gaps.

• Utilize project management skills to work with cross functional teams on delivery of solutions.

• Promote change through sharing of best practices.

• Leverage automation to achieve desired results.

• Interface with and manage all organizational levels to mobilize commitment.

• Perform claim adjudication project analysis and preparation work flow management.

• Develop and implement required Process Bulletins.

• Identify automation opportunities to decrease spend levels.

• Reduce adjustment volume through root cause analysis and correction.

Education/Experience

Bachelor's degree in a related field or equivalent experience. 5+ years of experience in health plan operations, preferably with Medicare and/or Medicaid or equivalent business experience. Ability to deal with abstract variables and apply principles of logic or scientific thinking to define problems, collect data, establish facts, and draw valid conclusions. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.

Pay Range: $107,700.00 - $199,300.00 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