Senior Manager, Claims Quality Improvement

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

Provide leadership and direction for continuous quality improvement (QI) initiatives to improve efficiency, processes and demonstrate improved quality. Provide and analyze reports to identify trends, opportunities and recommend initiatives aimed at improving quality of care and services provided by the organization.

Responsibilities

• Deep expertise in claims operations, payment accuracy, audit methodologies, quality management systems, regulatory requirements, and operational controls to identify risks, drive quality improvements, and ensure consistent business outcomes.
• Leverage data, root cause analysis, statistical methods, and Lean/Six Sigma principles to identify trends, address performance gaps, improve processes, and deliver measurable quality and financial results.
• Lead large-scale quality initiatives while maintaining a practical understanding of business systems, automation, reporting tools, and emerging AI capabilities to strengthen controls, improve productivity, and scale operations efficiently.
• Oversee accreditation process, specifically as it pertains to National Committee for Quality Assurance (NCQA) Accreditation and compliance with contractual requirements.
• Responsible for overall coordination of company-wide quality assessment and improvement activities.
• Oversee and coordinate with Corporate on annual file audits and other quality-related initiatives to include those of a contractual nature.
• Manage and implement appropriate work tools/processes, reports, and audit tools to ensure control of key processes and program characteristics.
• Recommend quality improvement opportunities based on findings and participate in developing and implementing solutions to management, the Quality Improvement Committee (QIC), and other committees as appropriate.
• Provide feedback to rectify errors and prevent further inconsistencies.
• Oversee monthly and quarterly reports and data to identify trends, opportunities for improvement, and interventions.
• Responsible for policies, operating procedures, and aligning goals in compliance with internal and external guidelines.

Requirements

• Bachelor’s degree in Business, Healthcare, or related field. Master's degree preferred.
• 5+ years of quality management experience or equivalent leadership experience.
• Previous experience as lead in functional area, managing cross-functional teams on large-scale projects or supervisory experience which includes hiring, training, assigning work, and managing the performance of staff.

Pay

$107,700.00 - $199,300.00 per year. 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

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible approach to work with remote, hybrid, field, or office work schedules

Benefits may be subject to program eligibility.