Jobs for Humanity is partnering with Centene to build an inclusive and just employment ecosystem. Therefore, we prioritize individuals coming from the following communities: Refugee, Neurodivergent, Single Parent, Blind or Low Vision, Deaf or Hard of Hearing, Black, Hispanic, Asian, Military Veterans, the Elderly, the LGBTQ, and Justice Impacted individuals. This position is open to candidates who reside in and have the legal right to work in the country where the job is located.

Company Name: Centene

We are looking for someone who can make a difference in the lives of our 28 million members. Centene is dedicated to improving the health of our communities, one person at a time. As a national organization, we offer competitive benefits and value workplace flexibility.

Oklahoma Complete Health, which is part of Centene, is committed to providing quality healthcare solutions to transform the health of the people of Oklahoma. We foster an inclusive culture that emphasizes work-life balance, competitive compensation, and continuous career development. Join us and become part of a collaborative and growing network of innovative thinkers who are making a difference in their local communities.

***Residence in Oklahoma is required for this position***

Position Purpose: As a liaison between Tier II providers and the health plan, your role will involve managing network performance, improving provider performance, and assisting with claim resolution. This includes evaluating performance, developing strategies for improvement, and conducting detailed analysis.

Your key responsibilities will include:

• Being the main point of contact and mediator between providers and the health plan
• Tackling provider issues by coordinating with internal teams for resolutions
• Dealing with external provider issues and addressing them effectively
• Investigating, resolving, and communicating provider claim issues and changes
• Educating providers about policies, procedures, and related topics
• Conducting provider orientations and ongoing education
• Managing network performance through a consultative/account management approach
• Evaluating provider performance and creating improvement strategies
• Driving provider performance in various areas such as risk management, quality, and cost
• Preparing detailed analysis and reports for meetings
• Becoming proficient in tools and value-based performance and helping providers understand and utilize them
• Assisting new and less experienced colleagues in their roles
• Completing special projects as assigned
• Ability to travel locally for 4 days a week

Education/Experience: To qualify for this position, you'll need a bachelor's degree in a related field or equivalent experience. Three years of experience in provider relations, provider claims/reimbursement, or contracting is required. Knowledge of healthcare, managed care, Medicare, or Medicaid is preferred. Knowledge of claims billing/coding is a plus.

Our Comprehensive Benefits Package: We offer flexible work solutions, including remote options and hybrid work schedules. Competitive pay, paid time off including holidays, health insurance coverage for you and your dependents, 401(k) and stock purchase plans, tuition reimbursement, and best-in-class training and development are also part of our benefits package.

Equal Opportunity Employer: Centene is an equal opportunity employer that celebrates diversity and values the unique contributions everyone brings. We embrace all qualified applicants, regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other characteristic protected by applicable law.