Position Purpose: Responsible for monitoring and oversight of Medicare enrollment operations, regulatory audits, and related initiatives that impact membership for product lines and health plans. Manage service levels and audit readiness; identify compliance risks, root causes, service opportunities, and process improvements.

Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Strong Medicare enrollment experience is highly preferred, including knowledge of enrollment transactions, member maintenance, cancellations, disenrollments, reinstatements, and CMS processing requirements.

Experience with CMS, state, corporate compliance, or other highly regulated operational audits is highly preferred, including audit preparation, documentation validation, findings, and root cause analysis.

Strong root cause analysis and analytical problem-solving skills are highly preferred, with the ability to identify recurring risks, determine why failures occurred, and support sustainable process improvements.

Intermediate to advanced Microsoft Excel skills are highly preferred, including formulas, pivot tables, graphs, and charts.

Schedule: Must be available to work Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern Time. Occasional extended or weekend hours may be required for urgent audit deadlines.

Travel: Up to 10% based on audit needs.

• Oversee implementation of programs centered on quality and operations excellence.
• Oversee status of production in assigned department to ensure production and quality goals are being met.
• Prioritize work volumes daily.
• Responsible for hiring, training, and performance management of staff.
• Monitor service levels to ensure compliance with state, federal, and company metrics and standards.
• Support ongoing and special projects including process improvement evaluations and analysis, department business development, ROI analysis, etc.
• Partner with stakeholders to address membership related initiatives including identification of business need, strategy recommendation, project outline, management of deliverables, and ROI.
• Develop and maintain collaborative relationships with health plans, IT partners, other business units and oversee training and business processes as necessary.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

• Associate's Degree Associate's degree in Business or related field or equivalent experience required.
• 2+ years supervisory/lead experience or management of large projects required.
• 2+ years business operations in such areas as enrollment and billing, contact center, claims, customer service, provider data management or similar operations required.
• 2+ years experience in managed care and/or Medicare environment preferred.

By applying to this requisition, you acknowledge and understand that you may be considered for other job opportunities for which Centene believes you may be qualified.

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 effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K 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.

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