Process Owner - Appeals

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: Utilizes business expertise to facilitate, lead and drive complex large scale work efforts across domains and/or large scale cross functional initiatives with matrixed team support. Analyzes and measures the effectiveness of existing business processes and develop sustainable, scalable and quantifiable business process improvements. Research industry best practices to ensure alignment of strategic planning, collaboration with key stakeholders, communication delivery, operational execution/implementation, and compliance and budget adherence. Delivers expertise in areas such as process improvement (end to end), vendor management, technology and scalability.

• Support strategy for complex business transformational priority
• Actively participate in the execution of complex business cases for proposed initiatives to ensure adequate assessment of feasibility, opportunities, risks and return on investment to meet key business objectives
• Aid in the activation of strategic and policy guidance on assigned initiatives so that all processes are considered for maximizing effective implementation and results
• Perform detailed analysis of data, workflows, policies, procedures, organization of staff, and skills to execute initiatives
• Collect and analyze process data to initiate, develop and recommend business practices and procedures that focus on enhanced effectiveness and increased productivity with a consideration for cost containment.
• Collaborate directly with stakeholder SME’s for knowledge transfer, training and implementation
• Confirm end to end integrity to accomplish project work up to and including final recommendations and implementation
• Partner on creation of timely communication to all key stakeholders and contribute to executive level presentations for support, awareness, and effectiveness of all deliverables
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience:

• Bachelor's Degree in a related field or equivalent experience required
• 5+ years of health care or insurance industry experience having led or been a key contributor on large scale initiatives required
• Operations experience preferred
• Appeals experience preferred
• Availity experience preferred

Certifications/Licenses:

• Certified Project Management Professional (PMP)-PMI preferred
• Certified Project Manager (IAPM) preferred
• CSSBB - Six Sigma Black Belt preferred

Pay Range: $105,600.00 - $195,400.00 per year

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.  Total compensation may also include additional forms of incentives.

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