Remote Claims Supervisor: Lead & Optimize Medical Claims

Centene Corp.; Illinois; Remoto; USD 56.000 - 101.000; Tempo pieno

Vantaggi offerti da questo lavoro

Health insurance

401K plan

Stock purchase plans

Tuition reimbursement

Paid time off

Descrizione del lavoro

Centene Corp. is seeking an experienced supervisor to oversee day-to-day claims operations. You will provide technical and leadership support to staff to resolve complex issues and ensure policies and procedures comply with state and federal regulations.

The role requires oversight of inventory management, prioritization of daily workloads, and driving process improvements with cost and regulatory considerations. Remote work from anywhere in the United States is supported.

Competenze

• Associate degree or equivalent experience required.
• 2+ years of health insurance industry, claims processing, physician’s office or other office services experience required.
• Previous supervisory/lead role with defined outcomes required.
• Experience with Medicaid, Marketplace and/or Medicare preferred.

Mansioni

• Provide oversight and support to ensure that Claims inventory is managed accurately, timely and within compliance - internal and regulatory requirements.
• Prioritize work volumes daily through reporting, load balancing, and managing operational overtime cost.
• Help to identify opportunities for improvements and resolve operational gaps/problems with a financial, regulatory, cost/benefit and stakeholder experience.
• Assist in reviewing, investigating, adjusting, and resolving all pending claims, especially complex claims. Serve as a point of escalation for these matters.
• Monitor claims quality reviews for accuracy, document results and identify trends and systemic root cause analysis.
• Point of contact for the team, for the plan and for other departments in researching, collecting background information and documentation and to address various issues.
• Responsible for preparing reporting, analysis and insights that is consistent with defined standards to drive operational excellence. Maintain appropriate records, files, documentation, etc.
• Special Project work as assigned.
• Facilitate change to support current and future business needs.
• Performs other duties as assigned.
• Complies with all policies and standards.

Conoscenze

Supervisory experience

Claims processing

Regulatory compliance

Formazione

Associate degree or equivalent experience

Descrizione del lavoro

Centene Corp. is seeking an experienced supervisor to oversee day-to-day claims operations. You will provide technical and leadership support to staff to resolve complex issues and ensure policies and procedures comply with state and federal regulations.

The role requires oversight of inventory management, prioritization of daily workloads, and driving process improvements with cost and regulatory considerations. Remote work from anywhere in the United States is supported.