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Senior Manager, Claims Contract Support job

CenteneColumbus, OH
Centene jobs

Company

Salary

Skills

Job Description

Senior Manager, Claims & Contract Support

Position Purpose: Manage the implementation all provider contracts, including any pertinent changes and modifications applicable to these contracts. Provide Health Plan management with all necessary data to allow for expedient resolution of claims issues.

- Oversee the claims operation function, including contracting and configuration

- Identify and manage risks, resolve conflicts and remove barriers that impede area's ability to achieve goals and performance expectations

- Provide management to expedite resolution of claims issues and support in policy decisions related to claims operations

- Manage and identify process improvement opportunities in the health plan's workflow to assure timely, accurate submission and implementation of contracts

- Perform random audits of provider setup within the provider information system to ensure accurate contract implementation and subsequent claims processing

- Act as health plan interface on software product upgrades and implementations that affect contract implementation

- Interface with all organizational levels to mobilize commitment and ensure accurate configuration, contract implementation, and claims operations

- Proactively interact with external stakeholders as it relates to new product implementations

- Serve as the subject matter expert in resolution of claims and configuration issues

- Conduct internal audits of contracts and related files to ensure compliance with corporate standards related to contracts and their implementation

Additional responsibilities for Pennsylvania Health & Wellness:
Manage the day to day responsibilities for the contract implementation and claims resources teams.
Collaborate with the encounters team to ensure encounters are submitted timely and correctly.

Education/Experience: Bachelor's degree in related field or equivalent experience. 6+ years of provider relations, provider contracting or claims administration experience, preferably in a managed care environment. Experience with Medicare and Medicaid claims and system configuration.

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.

Health Insurance Operations

USA-Ohio-Columbus

Buckeye Community Health Plan

Full-time
Estimated annual salary
$81,974
average
Minimum
$61,858
Maximum
$107,591

TASKS

  • Represent companies in negotiating contracts and formulating policies with suppliers.
  • Develop cost reduction strategies and savings plans.
  • Develop and implement purchasing and contract management instructions, policies, and procedures.
  • Prepare bid awards requiring board approval.

SKILLS

  • Reading ComprehensionUnderstanding written sentences and paragraphs in work related documents.
  • Active ListeningGiving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
  • WritingCommunicating effectively in writing as appropriate for the needs of the audience.
  • SpeakingTalking to others to convey information effectively.

KNOWLEDGE

  • Administration and ManagementKnowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources.
  • ClericalKnowledge of administrative and clerical procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology.
  • Economics and AccountingKnowledge of economic and accounting principles and practices, the financial markets, banking and the analysis and reporting of financial data.
  • Sales and MarketingKnowledge of principles and methods for showing, promoting, and selling products or services. This includes marketing strategy and tactics, product demonstration, sales techniques, and sales control systems.

Centene

Type

Company - Public (CNC)

Size

10000+ employees

Revenue

Over $10B

Location

Saint Louis, MO

Industry

Insurance

Founded

1984

CEO

Michael F. Neidorff

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