Director, Claims Business Implementation

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 e