Home
/
Comprehensive
/
Vice President, Claims Operations
Vice President, Claims Operations-April 2024
New York
Apr 26, 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
Consulting Member of Technical Staff
Job Description Consulting Member of Technical Staff - Oracle Cloud Engineering Infrastructure Development The Oracle Cloud Infrastructure (OCI) team can provide you the opportunity to build and oper
Plumbing Foreman
Description About Us: Founded in 1999, eTEC Mechanical is a full-service mechanical contractor providing engineering, installation and maintenance for HVAC, plumbing, piping and fire protection syste
Driver I
Job Description Position Summary: The Route Sales Driver is responsible for driving a company vehicle within an established route or territory and delivering goods and products to various customer lo
Denials Management Specialist
Overview This is a great opportunity to join a cohesive, family-oriented team with part-time hours. Our clinic offers great work hours and flexibility! We understand you have personal responsibilitie
Polysomnograph Technologist
Under the supervision of physicians the polysomnographic technologist is responsible for independent performance of patient care duties and providing customer service to clients of the sleep disorder
Lead Scientist Clinical Laboratory
JOB REQUIREMENTS: Help us change lives At Exact Sciences, we\'rehelpingchange how the world prevents, detects and guides treatment forcancer. We give patients and clinicians the clarity needed to mak
barista - Store# 17565, BEDFORD NH
Join us and inspire with every cup! At Starbucks, it’s all about connection. People are at the heart of who we are, especially the people that are a part of our store team. We connect with each other
Janitor
In most jobs, everyone doesn’t spontaneously erupt into applause and start raining down high-fives. At Buffalo Wild Wings, that’s just a Thursday night. This is the place to start the next phase of y
Data Center Design Engineer
Job Description The Oracle OCI team is looking for a Data Centre Design Engineer to join our team, someone who innovates & shares our passion for winning in the cloud marketplace. You will work c
Account Executive Officer / Underwriter
Who Are We? Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casu
Copyright 2023-2025 - www.zdrecruit.com All Rights Reserved