Home
/
Comprehensive
/
Vice President, Claims Operations
Vice President, Claims Operations-April 2024
New York
Apr 4, 2025
About Vice President, Claims Operations

Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members.

Position Purpose: Lead and manage a large scale organization accountable for the accurate, timely and efficient processing of Medical and Behavioral claims. Direct day to day operations of the claims departments and ensure the claims are processed within established government and company guidelines.

Set the strategic claims vision in compliance with federal, state and Company guidelines

Oversee the claims department and ensure quality claims metrics and service level agreements are met

Collaborate with leadership from internal departments to ensure efficiency and proper prioritization of the claims adjudication process

Develop, maintain, and ensure production and quality standards are met and audit outcomes

Ensure service levels and increase real time prioritization and productivity capabilities

Establish, evaluate, and implement processes and procedures to accomplish the organization’s and departments’ objectives

Ensure compliance with all state and federal claims payment laws and guidelines

Education/Experience: Bachelor’s degree in Business Administration, Management, or Finance; Master’s degree preferred. 10 years of experience in overseeing and developing claims operations, preferably in a managed care and/or Medicaid setting. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.

DE Only: A full-time Claims Director who will interact at the executive level and is responsible for all claims management activities, including claims processing, payment of claims, Third Party Liability, and Encounter Data reporting.Pay Range: $227,400.00 - $431,900.00 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.

Comments
Welcome to zdrecruit comments! Please keep conversations courteous and on-topic. To fosterproductive and respectful conversations, you may see comments from our Community Managers.
Sign up to post
Sort by
Show More Comments
SIMILAR JOBS
Merchandiser Stocker
Job Overview Merchandiser for Greater Moon Township, PA The Merchandiser is responsible for providing high-quality merchandising support for Keurig Dr Pepper brands like 7UP, Snapple, Core, Bai and o
Senior Member of Technical Staff
Job Description Cloud Engineering Infrastructure Development - Virtual Machine Control Plane At Oracle Cloud Infrastructure (OCI), we build the future of the cloud for Enterprises as a diverse team o
Customer Service Associate
Job Description: Models and delivers a distinctive and delightful customer experience. Registers sales on assigned cash register, provides customers with courteous, fair, friendly, and efficient chec
TSSCI Cyber Network Defense Analyst
Job Description An employer is looking for a TSSCI Cyber Countermeasures Analyst to sit at Fort Meade. This person is going to be responsible for being the subject matter expert of a specific system
Store Associate
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced
Security Officer
Allied Universal®, North America’s leading security and facility services company, provides rewarding careers that give you a sense of purpose. While working in a dynamic, diverse and inclusive workp
Special Education Teacher - Fortville, IN $45 Hourly
Special Education Teacher –Fortville, IN $45 Hourly Hours: 35 Location:Fortville, IN Start Date: asap $45 Hourly 23/24 school year, 6thgrade Requirements:IN SPED License The Special Education Teacher
School Bus Driver
School Bus Driver Location352 Concord Rd Sudbury, Massachusetts 01776 USPhone NumberCategoriesDriversReq IDJR367 School Bus Driver (Open) First for a reasonFirst Student is the largest school transpo
Cleaner
Overview Position Summary Details The Cleaner position provides the cleaning and upkeep of an assigned area. Essential Functions Cleans and maintains buildings/facilities. Performs heavy cleaning dut
Retail Cashier Part Time
Req ID: 431465 Address: 7791 NW 47th Ave Ocala, FL, 34482 Benefits: * Paid Time Off * Flexible Scheduling * 401(k) – 100% Match up to 5% * Medical/Dental/Vision Insurance after 30 days * Competitive
Copyright 2023-2025 - www.zdrecruit.com All Rights Reserved