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Senior Director, Claims Transformation

Company: Centene
Location: Saint Louis
Posted on: November 23, 2020

Job Description:

Senior Director, Claims Transformation Position Purpose: - Direct and oversee the end to end claims process and performance assurance programs across the operations. - Direct the day-to-day operations of the Claims Department to ensure accurate and timely processing of members medical claims within established state and company compliance guidelines. - This role will drive quality, compliance, and efficiency to ensure optimized metrics within the operations organization. - Lead the organization in the development of effective and efficient business processes that will meet or exceed internal and external performance expectations - Develop strategic vision and execution roadmap for quality and process improvement initiatives that establish a culture of quality by participating in long-range planning - Serve as the primary leader and expert regarding the end-to-end claims process - Partner with multiple stakeholders business unit and health plan leadership to establish operational objectives and procedures - Lead the organization in the development of effective and efficient business processes - Oversee implementation of operational efficiencies and development of 'best practice' policies and procedures - Provide strategic direction and leadership in developing innovative initiatives to improve overall quality outcomes - Monitor and analyze costs, prepare annual budget and operate department with the budget - Establish consolidated and consistent processes and relationships with internal and external partners to support the business in achieving its strategic and tactical objectives - Achieve and maintain all processing and expense standards relating to the Claim Operations - Collaborate with various cross-functional leaders to identify and execute process improvements and effective initiatives including the proposal and implementation of new technological tools. - Oversee all compliance standards for claims, ensuring operations are actively managing and reducing operational risk and introducing programs and initiatives to promote positive outcomes. - Oversee change management, and communication and dissemination of critical information to stakeholders, partners, leaders and peers both upstream and downstream - Assess progress and report statuses to upper management and key stakeholders including timelines and milestones - Analyze customer impact and respond to complex escalated customer service issues to ensure the customer expectations are consistently exceeded Education/Experience: Bachelor's degree or equivalent experience. Masters Degree preferred. 8+ years of claims operations, project management, process improvement or shared services experience, preferably in a managed care and/or Medicaid setting. Strong process improvement experience with a keen focus on quality. Previous experience with organizational and strategic business process design and development experience preferred. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff preferred. Preferred License/Certification: Six Sigma Black Belt, Certified Quality Manager, or other advanced quality certification preferred. 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. Claims Operations USA-Missouri-St. Louis Corporate Full-time

Keywords: Centene, St. Louis , Senior Director, Claims Transformation, Executive , Saint Louis, Missouri

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