Position Purpose: Oversee the day-to-day work functions of the assigned claims area, provide technical and leadership support to staff to resolve complex issues. The Supervisor will develop and implement policies and procedures that comply with state and federal regulations. Process improvement, cost control to process medical claims accurately and timely and serve as a liaison between internal customers, vendors and other stakeholders involved in the claims life cycle.
- Provide oversight and support to ensure that Claims inventory is managed accurately, timely and within compliance - internal and regulatory requirements.
- Prioritize work volumes daily through reporting, load balancing, and managing operational overtime cost.
- Help to identify opportunities for improvements and resolve operational gaps/problems with a financial, regulatory, cost/benefit and stakeholder experience.
- Assist in reviewing, investigating, adjusting, and resolving all pending claims, especially complex claims. Serve as a point of escalation for these matters.
- Monitor claims quality reviews for accuracy, document results and identify trends and systemic root cause analysis.
- Point of contact for the team, for the plan and for other departments in researching, collecting background information and documentation and to address various issues.
- Responsible for preparing reporting, analysis and insights that is consistent with defined standards to drive operational excellence. Maintain appropriate records, files, documentation, etc.
- Special Project work as assigned.
- Facilitate change to support current and future business needs.
- Performs other duties as assigned.
- Complies with all policies and standards.
Education/Experience: Associate degree in related field or equivalent experience required. 2+ years of health insurance industry, claims processing, physician’s office or other office services experience required. Previous experience in a supervisory/lead role with defined outcomes required. Experience with Medicaid, Marketplace and/or Medicare preferred.
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
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
