Senior Manager, Claims Quality Improvement

Centene
Missouri
Workplace: RemoteFull timeUSD 107,700 - 199,300 annuallyFunction: Quality & Regulatory (Non-Software)Education: bachelorsSkills: ["Analytical thinking","Problem-solving","Root cause analysis","Operational excellence","Leadership"]

Lead continuous quality improvement initiatives across a complex claims operation by using data, automation, and technology to strengthen controls, improve efficiency, and deliver measurable quality and operational results. Own claims and operational quality management, accreditation and audit activities (including NCQA), and company-wide quality assessment reporting. Collaborate with internal teams and committees to identify trends, drive root-cause remediation, and align processes with internal and external guidelines.

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FursaFursa
Centene
Centene
1 day ago

Senior Manager, Claims Quality Improvement

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Last checked: 2 hours agoStatus: Live

Job Summary

Lead continuous quality improvement initiatives across a complex claims operation by using data, automation, and technology to strengthen controls, improve efficiency, and deliver measurable quality and operational results. Own claims and operational quality management, accreditation and audit activities (including NCQA), and company-wide quality assessment reporting. Collaborate with internal teams and committees to identify trends, drive root-cause remediation, and align processes with internal and external guidelines.
Location: Missouri
Workplace: Remote
Employment Type: Full time
Job Function: Quality & Regulatory (Non-Software)
Seniority: Manager level

Key Responsibilities

  • •Provide leadership and direction for continuous quality improvement initiatives to improve efficiency, processes, and demonstrate improved quality.
  • •Oversee accreditation and compliance activities, including NCQA Accreditation and contractual requirements.
  • •Coordinate company-wide quality assessment and improvement activities, including annual file audits and other quality initiatives.
  • •Manage and implement work tools, processes, reports, and audit tools to ensure controls over key processes and program characteristics.
  • •Oversee monthly and quarterly reporting to identify trends and improvement opportunities; provide feedback to rectify errors and prevent inconsistencies.

Pay and Benefits

Salary: USD 107,700 - 199,300 annually
Perks:Health Insurance401kEquityPaid LeaveRemote Work

Key Requirements

  • •Bachelor’s degree in Business, Healthcare, or a related field; Master’s degree preferred.
  • •5+ years of quality management experience or equivalent leadership experience.
  • •Deep expertise in claims operations, payment accuracy, audit methodologies, quality management systems, and regulatory requirements.
  • •Experience leading large-scale quality initiatives and managing cross-functional teams on operational improvement projects.
  • •Experience in a supervisory/lead role, including hiring, training, assigning work, and managing performance.
Experience:HealthcareClaims operationsQuality managementAudit
Education:Bachelor's
Skills:Analytical thinkingProblem-solvingRoot cause analysisOperational excellenceLeadership
Tech Stack:DataAutomationReporting toolsAudit toolsAI

Company Brief

Centene
Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: St. Louis, United States
Founded: 1984
WebsiteLinkedIn