Supervisor, Financial & System Integrity

Cenetene Corporation; Austin (TX); Remote; USD 55,000 - 99,000; Full time

Job summary

A leading healthcare organization seeks a Supervisor for Financial & System Integrity to manage claims operations. This role involves overseeing staff, ensuring compliance with reimbursement guidelines, and enhancing departmental processes. Ideal candidates will have a Bachelor's degree and significant experience in claims processing within managed care.

Benefits

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work arrangements

Qualifications

• 3+ years of claims processing or provider contract experience in managed care.
• Experience managing cross-functional teams on large projects.

Responsibilities

• Manage activities and personnel within the Claims Operational Auditing Department.
• Research claims and validate reimbursement guidelines.
• Coordinate between departments to resolve claims issues.

Skills

Claims processing

Team leadership

Problem-solving

Communication

Education

Bachelor's degree or equivalent experience

Tools

Excel

Job description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose:

Manage all activities and personnel within the Superior Health Plan Claims Operational Auditing Department for Marketplace. Work closely with internal departments to identify claims issues, ensuring that claims reimbursement policies and state procedures are both timely and accurate.

In this Supervisor, Financial & System Integrity role, you will:

1. Research claims and validate correct reimbursement and processing guidelines.
2. Identify root causes of claims issues and collaborate with other departments to find remediation.
3. Coordinate between multiple departments to ensure smooth workflow and resolve or prevent claims issues.
4. Support staff with claims and process expertise to ensure timely and quality work completion.
5. Monitor, identify trends, and escalate issues to prevent member and provider abrasion, including avoiding compliance issues or penalties.
6. Manage workflow by organizing and prioritizing daily tasks to ensure timely completion.
7. Review, identify, and implement new processes within the department to enhance productivity and quality.
8. Evaluate performance, provide feedback, and implement improvements to ensure quality standards are met.
9. Identify training gaps and development needs to promote staff growth.

Education/Experience:

• Bachelor's degree or equivalent experience.
• At least 3 years of claims processing or provider contract experience in a managed care environment.
• Experience as a team lead or managing cross-functional teams on large projects.

Preferred Skills:

• Knowledge of claims payment and state reimbursement guidelines for Marketplace.
• Experience supporting large teams in supervisory or leadership roles.
• Intermediate proficiency in Excel.

Applicants may work remotely from anywhere in the Continental United States. The ideal schedule starts at 7:00 am Central Standard Time.

Pay Range: $55,100.00 - $99,000.00 per year.

Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off and holidays, and flexible work arrangements such as remote, hybrid, field, or office schedules. Actual pay will be adjusted based on skills, experience, education, and other factors. Total compensation may include additional incentives.

Centene is an equal opportunity employer committed to diversity. All qualified applicants will receive consideration regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other protected characteristics. Applicants with arrest or conviction records will be considered in accordance with applicable laws.