Remote Senior Payment Integrity Strategy Lead

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

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off

Job summary

Centene is seeking a Senior Business Process Consultant to lead business case development for proposed initiatives and support strategic planning. You will drive cross-functional, large-scale programs across Payment Integrity and Claims, partnering with technology and outside vendors to optimize processes and deliver measurable performance improvements.

The role requires strong data analysis, program leadership, and experience translating business needs into actionable requirements.

Qualifications

• Bachelor's Degree required; Master's Degree preferred.
• 6+ years managing projects experience in health care and/or insurance preferred.

Responsibilities

• Healthcare claims or Payment Integrity experience with knowledge of recovery, COB/TPL, subrogation, or related claims operations.
• Strong cross-functional program and process leadership skills, with experience partnering across business, technology, operations, and external vendors.
• Strong data analysis and performance monitoring skills, with the ability to evaluate operational and financial metrics and support reporting, audit, and compliance needs.
• Experience translating business needs into process or technology requirements and identifying opportunities for process improvement, automation, governance, and stronger operational controls a plus.
• Lead cross-functional initiatives across Payment Integrity, Claims, technology teams, and external vendors, coordinating priorities, dependencies, risks, and deliverables.
• Drive implementation and ongoing optimization of CRP-to-Claims processes, ensuring recovery activity is accurately integrated into claims operations.
• Manage complex exceptions, reconciliations, defects, and escalations, partnering with business and technology stakeholders to identify root causes and drive issues through resolution.
• 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.

Education

Bachelor's Degree in a related field

Master's Degree in a related field

Job description

Centene is seeking a Senior Business Process Consultant to lead business case development for proposed initiatives and support strategic planning. You will drive cross-functional, large-scale programs across Payment Integrity and Claims, partnering with technology and outside vendors to optimize processes and deliver measurable performance improvements.

The role requires strong data analysis, program leadership, and experience translating business needs into actionable requirements.