Director, Claims Configuration

The Director of Claims Configuration at Centene is responsible for overseeing the claims configuration and pricing/benefits setup within the claims payment system. This role ensures that provider contracts and claims payments are accurately reflected, manages timely configurations for new business implementations, and collaborates with stakeholders to gather business requirements, allowing for effective system setups.

To qualify for the Director of Claims Configuration role at Centene, candidates should have a Bachelor's degree in Business Administration, Health Care Administration, Information Technology, or a related field, along with a minimum of seven years of experience in configuration, claims adjudication, pricing or benefits setup, or contracting.

Centene values work-life balance and offers a flexible approach to work arrangements for the Director of Claims Configuration role. Employees can choose between remote, hybrid, field, or office work schedules, ensuring that you can manage both your personal and professional responsibilities effectively.

As a Director of Claims Configuration at Centene, you can expect a comprehensive benefits package that includes competitive pay, health insurance, a 401K plan, stock purchase options, tuition reimbursement, paid time off, and holidays. This package is designed to support your overall well-being and professional development.

The Director of Claims Configuration at Centene plays a crucial role in transforming healthcare for communities by ensuring that claims processing is accurate and efficient. By overseeing configurations and enhancing processes, you directly contribute to a better experience for the 28 million members we serve, ultimately leading to improved health outcomes.

When discussing your experience with claims configuration, highlight specific projects and roles where you successfully managed configurations and ensured compliance with provider contracts. Use metrics or outcomes to showcase how your actions positively impacted the claims process.

In answering this question, you should outline your method for stakeholder engagement, including interviews, workshops, and surveys. Emphasize the importance of clear communication and collaboration to ensure that all relevant information is captured effectively.

Discuss your knowledge of automation tools and techniques you have implemented in the past. Provide examples of processes you have automated, highlighting how these changes improved efficiency, reduced errors, and enhanced overall claims processing.

To address this question, explain your project management skills and approach to ensuring smooth transitions. Mention the importance of timelines, team collaboration, and thorough testing to minimize disruption during the integration phase.

Detail your process for reviewing provider contracts and ensuring their accurate reflection in the claims system. Mention your attention to detail and the systems you use for ongoing compliance monitoring.

Discuss industry trends affecting claims configuration such as regulatory changes, technological advancements, or shifts in healthcare delivery models. Show your understanding of these challenges and suggest proactive measures to address them.

This is a great opportunity to demonstrate your conflict resolution skills. Explain how you actively listen to stakeholder concerns and work toward a mutual solution while maintaining respect for differing viewpoints.

Emphasize the importance of data analysis in identifying trends, errors, and opportunities for improvement within claims configuration. Provide examples of how you have used data to make informed decisions and enhance operational efficiency.

When answering, share a specific instance of successfully implementing a change, including the challenges faced, the strategic plan executed, and the measurable results generated from this change.

Mention professional development activities such as attending industry conferences, participating in webinars, or pursuing certifications related to claims processing. Describe how you apply new knowledge to your work.