Senior Manager, Business & Systems Operations

Centene Management Company LLC; Missouri; Hybrid; USD 108,000 - 199,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Job summary

Centene is seeking a Senior professional to identify, manage, and oversee system and business requirements for health plan operations. The role is remote within the continental US, with responsibility for configuring and testing system builds for new markets and products.

The candidate should have 6+ years in health care operations or related fields, with experience in Medicaid/Medicare coding and contract/provider data management. Leadership experience is preferred.

Qualifications

• Bachelor's degree or equivalent experience.
• 6+ years of health care operations, system administration, product/program management or claims administration experience.
• Experience with Medicaid and Medicare coding, benefit design and various reimbursement strategies/methodologies.
• Previous management experience including hiring, training, assigning work and managing performance of staff.
• Contracting and provider data management experience preferred.

Responsibilities

• Identify and manage system and business requirements for new and existing business.
• Oversee setup of system builds for new markets and products, including configuration and testing.
• Monitor and evaluate trends in system performance and identify improvements.
• Establish and manage business specifications for authorization and claims/encounters systems.
• Identify and implement process improvements for new business implementations, claims performance, and auto adjudication.
• Oversee special projects to improve efficiency, productivity, and accuracy across the organization.

Skills

Health care operations

System administration

Product management

Claims administration

Education

Bachelor's degree in related field or equivalent experience

Master's degree preferred

Job description

Position Purpose:

Identify, manage and oversee the system and business requirements for new and existing business and ensure performance meets all health plan, state, and provider contract requirements. Key Details: 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. This is a remote role that can be based anywhere within the continental US. Oversee the successful setup of system builds for new markets and products system, including configuration and testing Monitor and evaluate trends in system performance and identify new opportunities or improvements Oversee and ensure timeliness and accuracy of all reporting deliverables Establish and manage business specifications for authorization and claims/encounters system infrastructure in alignment with all relevant requirements to maintain system specifications Identify and implement process improvements for various functions, including new business implementations, claims, encounters performance and auto adjudication, extensive testing benefit specifications, and system integrity Establish and manage special projects to improve processes to increase efficiency, productivity, and accuracy across the organization.

Education/Experience:

• Bachelor’s degree in related field or equivalent experience.
• Master’s degree preferred.
• 6+ years of health care operations, system administration, product/program management or claims administration experience.
• Experience with Medicaid and Medicare coding, benefit design and various reimbursement strategies/methodologies.
• Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.
• Contracting and provider data management experience preferred.

Pay Range:

$107,700.00 - $199,300.00 per year

Company Overview:

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
• 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.