Vice President, Claims Configuration Operations (Health Plan)
$171.9k - $326.9kCentene Management Company LLC
Position Purpose Oversee business operations, procurement opportunities, new product implementations and complex initiatives for business development utilizing cross‑functional business units and corporate teams to meet business unit and corporate strategic objectives. Key Responsibilities Partner with multiple stakeholders and leadership to establish strategic visions, operational objectives, and policies and procedures ensuring compliance with state contracts, related laws, regulations and executive orders. Monitor and report achievement of committed action plans to senior management. Direct the development and implementation of operational work processes and systems with direct oversight for multiple departments within the business unit. Accountable for budget, revenue targets, and profit and loss. Lead and oversee new business implementation and procurement activities for all products and complex projects, including RFP responses. Evaluate program opportunities and recommendations for effectiveness and ROI. Perform duties as senior liaison between the business unit, corporate, and external stakeholders. Oversee preliminary discovery, due diligence for potential liabilities, internal control weaknesses, and financial integrity. Qualifications Bachelor's Degree in Business Administration, Finance, Accountancy or a related field required. Master's Degree preferred. 9+ years of operations, management, or administration in the Healthcare or Insurance industry experience required. Experience in business development and/or Request for Proposal (RFP) preferred. Extensive knowledge of state legislative and regulatory processes preferred. Compensation & Benefits Pay Range: $171,900.00 - $326,900.00 per year. Centene offers a comprehensive benefits package including competitive pay, health insurance, 401(k) 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. EEO Statement 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. #J-18808-Ljbffr Centene Management Company LLC
$188.9k - $359.8k
...Centene is transforming the health of our communities one person at... ...including, access analysis, network operations and support decision makers... .... Oversee analysis of claim trend data and/or market information... ...diligence. Assist health plan CEO and/or COO vendors in key...OperationsClaimsHealth InsuranceFull timeContract workPart timeWork at officeRemote workFlexible hours- ...Medicaid HIV Special Needs Plan in NY, delivers a uniquely... ...innovation, engagement and member health outcomes. Our mission is to... ...to join our team as the Vice President of Operations. Compensation will be... ...administrative report to the Claims/Encounter, Reporting, Provider...OperationsClaimsHealth InsuranceContract work
$188.9k - $359.8k
...Centene is transforming the health of our communities one person... ...working closely with various operational areas to support provider services... ...development, data quality initiatives, claim processing and expansion of... ...providers and the health care plan to reduce rework, streamline...OperationsClaimsHealth InsuranceFull timePart timeWork at officeLocal areaRemote workFlexible hours- ...Vice President Clinical Practice Sagility combines industry‑leading technology... ..., payment integrity, claims cost containment, and analytics... ...clinicians. Manage/incubate operations for new UM and CM programs... ...of 5 years’ experience in a health plan or large health system/ACO...OperationsClaimsHealth InsuranceTemporary workWork experience placementCurrently hiringWork from homeFlexible hoursShift work
- ...the Chief Actuary, the Vice President of Actuarial Services... ...analytic functions for the Plan’s multiple product... .... Directs financial/claim analysis reports to support... ...on corporate-wide health care delivery cost and... ...oversight of risk adjustment operations for all product lines,...OperationsClaimsHealth InsuranceWorldwide
- ...Remote Jobs seeks an experienced analyst for configuration information management. This role involves managing claims databases and ensuring accuracy in contracts and... ...at least 5 years of experience in healthcare operations and proficiency in claims processing systems....OperationsClaimsHealth InsuranceWork at officeRemote work
- ...cycle leadership, clinical operations, and IT teams to ensure efficient... ...a large, multi-entity health system. Key Responsibilities... ...schedules, charge routing, claim configuration, edits, and billing workflows... ...health insurance, retirement plans, paid time off, and professional...OperationsClaimsHealth InsurancePermanent employmentFull timeRemote work
$72k - $89k
...Title: Clinical Care Configuration Analyst (Remote work) Location: Any location within... ...experience in a Systems Configuration, Claims, or Operations department within a healthcare organization... ...as Facets. Advanced knowledge of health plan configuration, including healthcare...OperationsClaimsHealth InsurancePermanent employmentRemote work$200k - $300k
...across commercial and government plans. This is a senior leadership... ...reimbursement, and align operationally across markets. Build scalable... ...within healthcare – across health plans, MSOs, or tech-enabled... ...Working knowledge of RCM and claims workflows sufficient to...OperationsClaimsHealth InsuranceContract workShift work$143.2k - $243.4k
...Chubb is a world leader in insurance. With operations in 54 countries, Chubb provides... ...insurance, personal accident and supplemental health insurance, reinsurance, and life insurance... ..., underwriting excellence, superior claims handling expertise and local operations...OperationsClaimsHealth InsuranceFull timeTemporary workLocal area$175k
...it most. The Regional Vice President (RVP) is a senior field... ...is digitally fluent, operationally disciplined, and highly... ...regional execution plans that drive broker engagement... ...into pipeline health, regional performance,... ...Operations, Product, Claims, and Technology teams...OperationsClaimsHealth InsuranceTemporary workLocal area- ...Arlo is rebuilding health insurance from the ground up using AI. The... ...by reimagining what a health plan should be: a proactive partner... ...underwriting, analytics, clinical, and operations teams. You will be working... ..., billing, eligibility, claims, and TPA‐related issues Coordinate...OperationsClaimsHealth Insurance
- ...United States Prognos Health is rapidly expanding... ...to help us scale our operations, and to better serve... ...We are hiring for Vice President, Business Development... ...marketplace including medical claims, prescription claims,... ...territory account plans, including prospect identification...OperationsClaimsHealth InsuranceImmediate startRemote workFlexible hours
$200k - $250k
...providers Delivers technology-enabled operational solutions to complex healthcare... ...-end operations for healthcare claim dispute resolution Build... ...Compensation $200k-$250k Full health, dental, and vision coverage Retirement savings plan through 401(k) Flexible time...OperationsClaimsHealth InsuranceFlexible hours$1,000 per month
...We offer more than 25 Health, Growth, and Wealth Work... ...And more! The Vice President of Clinical Performance... ...to the SVP, Clinical Operations and broader clinical operations... ...healthcare payor claims data around $PMPM, Unit... ...as supported in health plans, ACOs, and value-based...OperationsClaimsHealth InsuranceWork at officeLocal areaFlexible hours$235k - $305k
...Vice President, Product Glossier, Inc. New York, NY... ...equal parts visionary and operator, with a strong dose of... ...decisions across formulation, claims, naming, pricing,... ...Lead 3-year category planning and portfolio strategy... ...to assess category health and portfolio performance...OperationsClaimsHealth InsuranceFull timeContract workTemporary workLocal area$106k - $146k
...About Lyra Health Lyra Health is the leading provider... ...in overall healthcare claims costs. Lyra is... ...looking for a strong Claim Operation Manager of Revenue Cycle... ...for health plan accounts receivable activities... ...teams to ensure accurate configuration and process alignment....OperationsClaimsHealth Insurance$77.76k - $149.04k
...and management of Other Health Insurance (OHI),... ...regulatory requirements, and operational excellence within COB... ...initiatives to reduce claim overpayment, improve... ..., Medicaid, Essential Plan, Exchange, and Commercial... ...Management, Contract Configuration, Provider File...OperationsClaimsHealth InsuranceContract workWork experience placementRemote work$103.4k - $149.43k
...Claims And Provider Payment Modernization Manager... ...represents Healthfirst Operations in the support of defined... ...into new standard configurations and new systems. This... ...improvement and implementation plans, assisting with... ...change initiative in a health plan setting Demonstrated...OperationsClaimsHealth InsuranceTemporary workWork experience placement- Claims and Provider Payment Modernization Manager Represents Healthfirst Operations in support of defined claims-related and... ...into new standard configurations and new systems.... ...and implementation plans, assisting with operational... ...initiatives in a health‑plan setting....OperationsClaimsHealth InsuranceWork experience placement
$171k - $288k
...customers need it most. The Vice President, Head of Underwriting... ..., Finance, and Operations to align underwriting... ...paths, and succession planning within the underwriting... ...portfolio management Claims on risk‑experience feedback... ..., and Supplemental Health. Proven leadership of...OperationsClaimsHealth InsuranceTemporary work$21 - $25 per hour
...complete tasks related to provider configuration. Communicate provider changes to contracted health plans and FCS, AMGR, and AMGBA... ...analysts, Revenue Cycle, and Operations to correct provider setup, payer... ...components required for clean claim submission. Independently troubleshoot...OperationsClaimsHealth InsuranceContract workWork at officeLocal areaFlexible hours$154.6k - $236.56k
...Director Of Configuration, Benefit Administration The Director of... ...with Provider Contracting, Claims Operations, Provider Data Management,... ...aspects are accounted for in planning and implementation of... ...experience Proven experience in health insurance focused on claim...OperationsClaimsHealth InsuranceContract workTemporary workWork experience placementWork at officeFlexible hours3 days per week$59.81k - $129.59k
...analysis of complex healthcare claims data, pharmacy data, and... ...healthcare utilization and operations reports and makes recommendations... ...and organization of health plan initiatives, facilitating the... ...Claims, Utilization Management, Configuration, and Payment Integrity to understand...OperationsClaimsHealth InsuranceContract workWork experience placementRemote work- ...searching for a Director of Claims Quality. This is a... ...Director of Claims Operations and Director of Program... ...performance improvement plans are created,... ...Liaison between claims and configuration to ensure claims rules... ...Experience with multiple health plan operational departments...OperationsClaimsHealth InsurancePermanent employment2 days per week
$145k - $190k
...on selling Cotiviti’s Dental Claim Accuracy solutions to Dental... ...Administrators (DBAs) and Health Plans that administer dental benefits... ...C‑suite executives, Dental Operations leadership, Claims, Policy,... ...with: Dental Plan Executives (President, GM, EVP). Dental...OperationsClaimsHealth InsuranceContract workWork at officeImmediate startRemote work$160k - $180k
...delivers measurable value for health plan clients. Opportunity... ...health plan clients. You will operate at the intersection of Product... ...automation teams to: Drive configuration, rules, and AI automation strategy... ...data with post-service claims validation, we’re creating a...OperationsClaimsHealth InsuranceContract workRemote workFlexible hours$85k - $100k
About Judi Health Judi Health is an enterprise health... ...employers and health plans, including: Capital... ...consolidates all claim administration-related... ...crucial member of our Data Operations team, responsible for... ...exchange processes, configurations, and troubleshooting...OperationsClaimsHealth InsuranceWork experience placementLocal areaRemote workFlexible hours$325k - $400k
...Executive Officer, North America, the Vice President, Head of U.S. Commercial Operations Excellence will play a pivotal and... ...in strategic and tactical plans of the U.S. innovation medicines businesses... ...and tactics. Utilize various claim data sources to identify patients...OperationsClaimsHealth InsuranceFlexible hours$76.8k - $121k
...About Judi Health Judi Health is an enterprise... ...employers and health plans, including: Capital... ...consolidates all claim administration-related... ...Accountable for configuration, load, and maintenance... ...of PBM or Health Plan operations experience handling adjudication...OperationsClaimsHealth InsuranceWork experience placementLocal areaRemote workFlexible hoursShift work
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