Director, Claim & Contract Support Services (Medicaid Claims/Reimbursements)

You could be the one who changes everything for our 26 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.

• Applicants for this job have the flexibility to work remote from home and must reside in NC. Must be able to be in Raleigh office on Tuesdays and Thursdays.

Position Purpose: Direct the strategic analysis and accuracy of Claims processes and oversee and ensure compliance with state regulations and/or provider contracts.

• Oversee the collection, validation and analysis of data to deliver business solutions ensuring claims payment accuracy, efficiency and quality
• Monitor performance, evaluate, develop and implement business solutions to improve process and quality gaps
• Identify improvement opportunities and promote change through sharing of best practices
• Leverage automation to achieve desired results by reviewing and implementing new processes and technological tools
• Perform claim adjudication project analysis and preparation work flow management
• Coordinate the implementation of new product or health plan expansions
• Formulate and establish policies, operating procedures and goals in compliance with internal and external guidelines
• Oversee annual operating plan process and new business initiatives

Education/Experience: Bachelor's degree in a related area or equivalent experience. 7+ years of claim processing payer support services experience in a healthcare environment. Previous Medicaid experience preferred. Previous finance/budget experience preferred. Xcelys knowledge a plus. Configuration, claims operations and billing background preferred. Lean Six Sigma Certification is preferred.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

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.