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Senior Director, Claims Transformation

St. Louis , MO, USA | Centene Corporation

  • Industry:
    Healthcare - Hospitals
  • Position Type:
  • Functions:
    Operations / Production
  • Experience:
    7-10 years
Job Description:
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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.

Position Responsibilities:

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.

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