Supervisor, Financial & System Integrity

Centene; United States; Remote; USD 55,000 - 99,000; Full time

Job summary

Centene is seeking a Supervisor for the Financial & System Integrity team to manage claims operations and ensure compliance with reimbursement policies. This role involves leading a team, monitoring workflows, and collaborating across departments to resolve claims issues. The position offers flexibility to work remotely within the Continental United States.

Benefits

Comprehensive benefits package including health insurance and 401K

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules

Qualifications

• 3+ years of claims processing or provider contract experience in a managed care environment.
• Previous experience as a lead in a functional area or managing cross functional teams.

Responsibilities

• Manage all activities and personnel within the Claims Operational Auditing Department.
• Research claims and validate reimbursement and processing guidelines.
• Monitor, identify trends and escalate issues to prevent compliance penalties.

Skills

Knowledge of claims payment and state reimbursement guidelines

Intermediate Excel

Education

Bachelor's degree or equivalent experience

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 Market Place. 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:

• Research claims and validate correct reimbursement and processing guidelines
• Research claims, identify root cause and work with other departments to find remediation
• Collaborate between multiple departments to ensure smooth transition of work to resolve or prevent claims issues
• Provide support and claims and processes expertise to staff to ensure work is completed on time and quality is met
• Monitor, identify trends and escalate issues to prevent member, provider abrasion to include preventing compliance and or penalties.
• Manage workflow and monitor daily activities by organizing and prioritizing task to ensure completion is timely
• Identify, review, and implement new processes within the department to enhance productivity and quality
• Monitor and track performance by evaluating, providing feedback to improve quality
• Support development by identifying training gaps and development needs to improve growth

Education/Experience:

• Bachelor's degree or equivalent experience.
• 3+ years of claims processing or provider contract experience in a managed care environment.
• Previous experience as a lead in a functional area or managing cross functional teams on large scale projects.

Preferred Skills:

• Possess knowledge of claims payment and state reimbursement guidelines for Market Place
• Experience supporting a large team in a supervisory/leadership role
• Intermediate Excel

*Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States. Due to the needs of the business, ideal schedule starts at 7:00am Central Standard Time. *

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

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 Market Place. 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:

• Research claims and validate correct reimbursement and processing guidelines
• Research claims, identify root cause and work with other departments to find remediation
• Collaborate between multiple departments to ensure smooth transition of work to resolve or prevent claims issues
• Provide support and claims and processes expertise to staff to ensure work is completed on time and quality is met
• Monitor, identify trends and escalate issues to prevent member, provider abrasion to include preventing compliance and or penalties.
• Manage workflow and monitor daily activities by organizing and prioritizing task to ensure completion is timely
• Identify, review, and implement new processes within the department to enhance productivity and quality
• Monitor and track performance by evaluating, providing feedback to improve quality
• Support development by identifying training gaps and development needs to improve growth

Education/Experience:

• Bachelor's degree or equivalent experience.
• 3+ years of claims processing or provider contract experience in a managed care environment.
• Previous experience as a lead in a functional area or managing cross functional teams on large scale projects.

Preferred Skills:

• Possess knowledge of claims payment and state reimbursement guidelines for Market Place
• Experience supporting a large team in a supervisory/leadership role
• Intermediate Excel

*Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States. Due to the needs of the business, ideal schedule starts at 7:00am 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 plus holidays, and 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. Total compensation may also include additional forms of incentives.

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

About the company

Centene Corporation is a publicly traded managed care company based in St.

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