索赔业务实施总监
Director, Claims Business Implementation
职位职责 - 监督产品/计划在理赔业务单元中的实施，确保与战略和目标一致，并在实施流程、方法和模型上保持一致性，这可能包括新市场、重新采购或扩展，以及监管和合同变更。
- 指导理赔实施方法的标准模型的创建和维护。
- 在实施阶段负责所有理赔和配置运营功能。
- 提供理赔业务实施过程的战略领导和监督；管理公司对标准实施流程的遵守情况，包括与理赔流程负责人合作，对商业需求文档（BRD）批准拥有决策权。
- 提供对运营模型的输入；标准企业功能和信息系统模型、绩效指标、预期结果和计划影响，视情况而定。
- 指导理赔业务实施以满足预算、时间表和范围要求。
- 参与业务规划过程并为新健康计划业务实施制定时间表。
教育/经验：相关领域的学士学位或同等经验。硕士优先。7年以上项目管理经验，包括对项目管理方法和工具的详细理解和应用经验。5年以上政府项目管理护理经验，涵盖多个运营领域（理赔、供应商/会员服务/医疗管理/网络等）。有医疗补助管理护理经验者优先。
薪资范围：每年148,000.00至274,200.00美元
在Centene，我们帮助人们获得他们需要的医疗服务，过上更健康的生活——你在这里的工作每天都会带来真正的影响力。你将面对直接支持个人、家庭和社区的有意义挑战，在提升技能的同时让医疗保健更加可及和高效。这是你能看到成果的工作，由一支致力于在工作日之外改善生活的团队所支持。
Centene提供全面的福利包，包括具有竞争力的薪酬、健康保险、401K和股票购买计划、学费报销、带薪休假及节假日，以及灵活的工作安排，包括远程、混合办公、现场或办公室工作。实际薪酬将根据个人技能、经验、教育和其他法律允许的与工作相关因素进行调整，包括
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Position Purpose - Oversee the implementation of products/plans into Claims business units, ensuring alignment with strategies and goals and consistency in implementation processes, methodology, and models, which could include new markets, reprocurements or expansions, as well as regulatory and contract changes.
- Direct the creation and maintenance of standard models for the claims implementation approach.
- Responsible for all Claims and Configuration Operations functions during implementation phase.
- Provide strategic leadership and oversight of the claims business implementation processes; managing company adherence to standard implementation processes, including decision authority on Business Requirements Document (BRD) approvals in collaboration with Claims Process Owner.
- Provide input into operating models; standard corporate functional and information system models, performance metrics, expected outcomes and plan impacts, as appropriate.
- Direct claims business implementations to meet budget, timeline and scope requirements.
- Provide input into the business planning process and develop timelines for New Health Plan Business Implementations.
Education/Experience: Bachelor's degree in related field or equivalent experience. Master's degree preferred. 7+ years of project management experience, including detailed understanding and experience applying project management methodologies and tools. 5+ years of Government Programs Managed Care experience in multiple areas of Operations (Claims, Provider/Mbr Services/Medical Management/ Network, etc). Medicaid Managed Care experience preferred.
Pay Range: $148,000.00 - $274,200.00 per year
At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
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
Originally posted on Himalayas