Director, Business Claims Analysis

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.
 

Applicants for this position have the flexibility to work remotely anywhere in the Continental United States.

Position Purpose: Manage a team responsible for identifying and implementing solutions for business optimization. The team also supports business and root cause analysis, issue mitigation and management, and strategic initiatives. This role will support the strategic oversight of the department, leveraging knowledge of healthcare, Centene, business improvement/transformation, organization change management, customer experience, and strategy. Finally, the role will evaluate opportunities to and complete Cost Benefit Analysis to identify and estimate Return on Investment (ROI) savings or cost avoidance scenarios.

• Leads a team of professionals in guiding the business to achieve operational efficiency. Provides coaching and mentoring to develop associates including career pathing within the department.
• Leverages superior knowledge of healthcare, Centene, business improvement/transformation, organization change management, customer experience, and strategy, to provide training and enforcement of the eBT methodology tools and techniques.
• Establishes true partnership through learning the business / technology, building trust, and providing value.
• Provides guidance, leadership and encourages collaboration with Senior Management.
• Partners with senior management and seeks identification of new initiatives including scope, problem statement, stakeholders, and expected outcomes necessary to guide portfolio prioritization.
• Leads execution of an Enterprise Prioritization Assessment where applicable.
• Demonstrates thought leadership through out of the box thinking and leveraging deep Centene knowledge of business processes and systems.
• Leads highly complex or sensitive initiatives, which may involve Legal / Compliance or results in significant organizational, process, and technology impacts.
• Ensures appropriateness of overall initiative scope, multi-year strategy, and implementation plan to achieve operational efficiency and deliver excellent customer experience.
• Ensures establishment of a governance framework elements including strategy map, policy / procedure, balanced scorecard and operational reporting, problem and escalation management, risk and compliance mitigation, resource / vendor management, and training / communication for assigned initiatives.
• Oversees the measure to validate and ensure completeness, accuracy, and value add in support of superior quality product delivery.
• Ensures proposed business valuation maximizes impact with an emphasis on hard dollar Return on Investment (ROI) savings or cost avoidance scenarios.
• Produces executive level reporting demonstrating department goals achievement including ROI, on-time delivery, internal customer satisfaction scores.
• Acts as a change agent and strive to build unity at a time of change.
• Applies project management techniques to ensure on-time, high-quality deliverables.
• Performs other duties and special projects as assigned.

Education/Experience:

• Bachelor’s degree in related field.

• 8+ years of experience in at least three of the following: process improvement/transformation, business/financial analysis, external consulting/auditing/risk analysis, customer journey/experience, organizational change management, IT solution/architecture, project management

License/Certification:

• Organizational Change Management (PROSCI, Six Sigma CAP, Kotter, Bridge’s Rogers Kubler), CEX, CMMI, Six Sigma, PMP preferred

Pay Range: $145,100.00 - $268,800.00 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