Delaware First Health Hiring for Director, Claims Operations Full Time

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Provide direction and oversight for the operations of the Claims organization within established enterprise, state, and federal compliance guidelines with a focus on continuous improvement.

Develop workforce strategy that attracts, retains, and develops talent that meets the evolving needs of the organization.
Safeguard the successful maintenance of all claims processing activities and standards within established compliance, timeline, and quality guidelines.
Collaborate and coordinate with key stakeholders to ensure dependencies are well understood and addressed within the Claims organization and allow success in operational objectives.
Act as a key driver for change to support growth initiatives and continued business improvement and transformation.
Use data, technology and innovation to drive continuous improvement to identify, assess and resolve issues across Claims.
Serve as escalation point to minimize customer impact and ensure that customer expectations are consistently met.

Education/Experience: Bachelor’s degree in Business, Healthcare Management or related field. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff required.

• 7+ years of Claims Operations management required.
• Experience leading large-scale efforts (change, implementation, digital/technology, financial management) through data analysis and insights required.
• 5+ years of healthcare experience in multiple areas of Operations (Claims, Provider/Member Services, Medical Management, Network/IT, etc.) preferred.

Certifications: Project Management Professional Certificate (PMP) and/or Lean Six Sigma Certification (e.g. green belt, black belt, master black belt or other) preferred

DE Only: Resolves provider billing and payment issues, including providing technical assistance to all participating providers to resolve claims issues. Understands provider billing and payment requirements across all lines of business and is well-versed in payment systems.

Our 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.