Senior Manager, Claims Quality Improvement

You could be the one who changes everything for our 28 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 leadership and direction for continuous quality improvement (QI) initiatives to improve efficiency, processes and demonstrate improved quality. Provide and analyze reports to identify trends, opportunities and recommend initiatives aimed at improving quality of care and services provided by the organization.

• Claims & Operational Quality Management: Deep expertise in claims operations, payment accuracy, audit methodologies, quality management systems, regulatory requirements, and operational controls to identify risks, drive quality improvements, and ensure consistent business outcomes.
• Analytical Thinking & Continuous Improvement: Strong analytical and problem solving skills with the ability to leverage data, root cause analysis, statistical methods, and Lean/Six Sigma principles to identify trends, address performance gaps, improve processes, and deliver measurable quality and financial results.
• Operational Excellence & Technology Enablement: Ability to lead large-scale quality initiatives while maintaining a practical understanding of business systems, automation, reporting tools, and emerging AI capabilities to strengthen controls, improve productivity, and scale operations efficiently
• ​Oversee accreditation process, specifically as it pertains to National Committee for Quality Assurance (NCQA) Accreditation and compliance with contractual requirements.
• Responsible for overall coordination of company-wide quality assessment and improvement activities.
• Oversee and coordinate with Corporate on annual file audits and other quality related initiatives to include those of a contractual nature.
• Manage and implement appropriate work tools/processes, reports and audit tools to ensure control of key processes and program characteristics.
• Recommend quality improvement opportunities based on findings and participation in developing and implementing solutions to management and the Quality Improvement Committee (QIC) and other committees, as appropriate.
• Provide feedback to rectify errors and to prevent further inconsistencies.
• Oversee monthly and quarterly reports and data to identify trends, opportunities for improvement and interventions.
• Responsible for policies, operating procedures, and aligning goals in compliance with internal and external guidelines.

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