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Vice President, Operations

Company: Centene Corporation
Location: Tallahassee
Posted on: September 23, 2022

Job Description:

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 26 million members.Position Purpose: In collaboration with the executive leadership, this position will provide overall strategy and direction of the claims processing, member services and customer services functions. Establishes claims processing, membership eligibility and customer services policies and procedures that enhance claims processing, claims audit and reimbursements. Assures the proper servicing and reimbursement of all claims incurred by company. Reviews analyses of critical success factors, cost, operational improvement initiatives and forecasts data to determine the progress toward stated goals and objectives. Participates in the direction and control of the review and settlement of high dollar or potential claims, as well as any claims that are beyond the authority of subordinate claims associates. Confers with Sr. Vice President, Health Plan operations to review achievements and discuss required changes in goals or objectives resulting from current status and conditions. Develops and implements the strategic business plan for Health Plan Operations with focus on capacity requirement, state of the art claims processing, membership eligibility and customer service capability and world class performance on key indicators. Directs and coordinates activities necessary in developing work process flows. Ensures the development of quality standards by accurate volume forecasting and staffing. Provides guidance to the development of a process improvement plan, including FTE requirements and other resources. This includes ITG requirements. Ensures all established timelines and commitments are met or exceeded. Coordinates claims processing, membership eligibility and customer service activities with all other functions of the organization. Reviews member service and claims processing activities with respect to financial results and quality standards. Reviews operational results and takes corrective actions as needed. Develops organizations talent aligned with Companys strategic objectives. Performs administrative functions associated with keeping management and the organization informed of key operational activities. Determines responsibilities and compensation of assigned organization and staff positions to accomplish business objectives. Trains and ensures all assigned employees are aware of and comply with Company, government, and customer policies, procedures, and regulations.Education/Experience: Bachelors Degree and ten years related experience and/or training; or equivalent combination of education and experience.Experience in managing, designing or implementing computer systems, in the customer service or claims processing areasOur Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.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.TITLE: Vice President, OperationsLOCATION: Various, FloridaREQNUMBER: 1341157

Keywords: Centene Corporation, Tallahassee , Vice President, Operations, Executive , Tallahassee, Florida

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