Search the 105 jobs at Centene Corporation

The Provider Engagement Network Specialist ensures accurate provider setup in the information system for claims processing and directories. Responsibilities include resolving provider data issues, maintaining provider directories, auditing provider data, and providing education and training to providers.

As a Grievance and Appeals Coordinator I, you will analyze and resolve claims and authorization appeals, handle verbal and written complaints from members and providers, maintain files on appeals and grievances, and support related functions such as data entry and HEDIS production.

The position involves managing daily operations of provider data management, including overseeing data entry, analysis, and issue resolution, ensuring data quality, leading team workflows, and facilitating meetings with health plan representatives. The role also includes training and mentoring other team members.

The Senior Application Architect is responsible for designing and implementing architectural software systems for Payment Integrity and Accuracy. They lead the vision for services using AWS serverless technologies, ensuring security and scalability, while collaborating with product and engineering teams. The role involves documenting solutions, performing security reviews, mentoring teams, and maintaining high delivery standards for software components.

The Regional Agency Manager is responsible for achieving annual sales goals in the Medicare sector by engaging with local organizations, brokers, and agencies. The role involves addressing escalated issues, providing training, and maintaining strong market knowledge while building internal relationships. Frequent travel within Southern California is required.

As a Regional Agency Manager, you will meet sales goals, engage with local organizations, conduct Medicare training, and build relationships to grow Medicare product lines while responding to escalated account issues. This role requires significant travel within the assigned region.

The Informatica IDMC Administrator II is responsible for administering IT tools and web applications, including configuration, maintenance, troubleshooting, and support. They implement application updates, manage backups, resolve production problems, and develop monitoring processes in collaboration with stakeholders.

The Community Resource Coordinator II connects members to community resources, supports care management journeys, and assists in community outreach. This field-based role involves conducting assessments, providing health education, and supporting the clinical team in facilitating successful community connections.

As a Lead Systems Engineer, you will oversee system engineering projects, provide technical direction, and mentor team members. Responsibilities include planning and implementing IT solutions, managing project timelines and budgets, troubleshooting infrastructure issues, and ensuring compliance with policies and standards.

The Senior Technical Platform Owner translates business problems into technical features, creates product technical road maps, works with stakeholders to define requirements, and captures user stories. The role involves research, enhancement of business systems processes, and collaboration with various teams for product development, ensuring alignment with user needs and technical objectives.

The DSNP Project Manager III is responsible for planning, organizing, and overseeing complex projects while managing the full project life cycle. This includes requirements gathering, resource management, budget oversight, and project execution. The role also involves maintaining project documentation, communicating project status, and coordinating cross-functional teams to meet strategic objectives.

Oversee Claims Liaison and Contract Implementation Analyst teams, managing claims operations, monitoring staff performance, and providing data to resolve claims issues. Serve as subject matter expert for claims and configuration, ensure accurate submission of contracts, and promote best practices across the organization.

The DSNP Project Manager II will manage the full project life cycle, including requirements gathering, project planning, resource management, budget management, and ensuring project execution and closure. Responsibilities include communicating project status to stakeholders, maintaining documentation, coordinating meetings, and ensuring project deliverables meet quality standards.

The Product Operations Specialist Associate will support the operational maintenance of products by managing relationships, identifying process improvements, analyzing performance, and ensuring compliance with contractual requirements. The role involves creating reports, guiding project implementations, and assisting in strategic planning activities.

The Compliance Specialist will ensure adherence to contractual and regulatory requirements, act as a compliance resource, and oversee health plan policies. Responsibilities include conducting audits, developing compliance policies, and coordinating compliance projects in the government relations area.

In this role, you will support the Buckeye Healthplan Finance team by developing and analyzing financial reports, forecasting expenses, and presenting findings to senior management. You will also ensure accurate recording of financial information and identify trends in competitive environments.

The Quality Improvement Specialist conducts audits of Primary Care Physicians and associated facilities to ensure compliance with regulatory standards. The role involves managing scheduling, documenting findings, developing reports, and providing training and technical assistance to improve accessibility for members, while maintaining confidentiality and adhering to policies.

The Senior Manager of Incident Response leads the Cybersecurity Incident Response Team, managing security incidents, recommending process improvements, and ensuring compliance with security policies. They are responsible for hiring and training staff, developing team capabilities, and delivering presentations to senior leadership on cybersecurity matters.

The Program Manager III is responsible for designing and implementing innovative talent management programs with a focus on rotational programs. This role involves managing projects throughout their lifecycle, collaborating with various stakeholders, and maintaining project documentation. The position requires effective communication and leadership skills to align projects with organizational goals.

Supervises the prior authorization request process, ensuring compliance with contract requirements and performance standards. Guides the authorization team, monitors requests inventory, implements process improvements, provides coaching, and develops onboarding and training for team members while communicating risks to management.