Payment Integrity Specialist - Strategic Initiatives

Centene; United States; Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules (remote,Hybrid

Job summary

Centene is seeking a Senior Business Process Consultant to lead business case development for proposed initiatives, support the strategic planning process, and drive large-scale, cross-functional programs. You will guide opportunity assessments, align initiatives with the strategic plan, ensure proper transition of approved cases into initiatives, and provide policy guidance to maximize impact.

The role requires strong project leadership, data analysis, and experience in healthcare or insurance.

Qualifications

• Bachelor's Degree in a related field or equivalent experience.
• Master's Degree in a related field preferred.
• 6+ years managing projects required.
• Experience in health care and/or insurance preferred.

Responsibilities

• Lead business case development for initiatives to assess opportunities, risks and ROI.
• Support planning and prioritization within strategic and business planning processes.
• Ensure initiatives align with the strategic business plan and are executed effectively.
• Transition approved business cases to initiatives with clear ownership.
• Lead cross-functional initiatives to drive performance, financial gains, customer satisfaction and compliance.
• Provide strategic guidance to maximize implementation impact and results.
• Organize teams, drive consensus, develop project plans and oversee implementation.
• Perform detailed analysis of data, workflows, and staffing to drive initiatives.
• Utilize project management tools (Excel, PowerPoint, Visio, MS Project).
• Support other project leaders in facilitation, mapping and analysis.
• Communicate across all levels to ensure awareness and effectiveness of process improvements.

Skills

Project management

Stakeholder management

Business case development

Data analysis

Education

Bachelor's Degree

Master's Degree preferred

Job description

Position Purpose

The Senior Business Process Consultant leads business case development for proposed initiatives, supports the strategic planning process, and leads larger scale, cross-functional initiatives.

• Leads business case development for proposed initiatives to ensure adequate assessment of opportunities, risks and return on investment.
• Provides input and supports planning and prioritization of initiatives as part of the strategic and business planning process.
• Ensures that initiatives support the strategic business plan, meet key business objectives and are executed well tactically.
• Ensures that all approved business cases are transitioned to initiatives (both documentation and clear responsibilities for each initiative).
• Leads larger scale, cross-functional initiatives that are intended to drive performance improvement, financial gains, customer satisfaction and improved compliance.
• Provides strategic and policy guidance on assigned initiatives so that all processes are considered for maximizing effective implementation and results.
• Organizes work teams, drives consensus and ensures end to end policy/process integrity to accomplish project work: including identification and confirmation of participants, establishment of a project plan, consistent work team engagement and productivity, meeting facilitation, consensus building, recommendation documentation and implementation oversight.
• Performs detailed analysis of data, workflows, policies, procedures, organization of staff, and skills in order to execute initiatives.
• Supports the project work by utilizing project management software such as, but not limited to, Excel, PowerPoint, Visio, and Microsoft Project.
• Leads all levels of staff who are responsible for initiatives included in the companies operating plan in order to support their success, development and effective completion and communication of their initiative.
• Assists other project leaders in specific areas as needed such as facilitation, analysis, process mapping, brain-storming, project management issues, etc.
• Writes and delivers communication to all levels of organization to ensure support, awareness and effectiveness of process improvement initiatives.
• Provides other related support as needed to improve the performance of the business.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience

• Bachelor's Degree in a related field or equivalent experience required
• Master's Degree in a related field preferred
• 6+ years managing projects required
• Experience in health care and/or insurance preferred

Licenses/Certifications

• Certified Project Management Professional (PMP)-PMI required
• Process quality certification preferred
• Certified Project Management Professional (PMP)-PMI For Health Net and Enterprise Business Operations only preferred

Pay Range

Pay Range: $87,700.00 - $157,800.00 per year

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.

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules

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.

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