Remote Claims Jobs in Decatur, IL (NOW HIRING)

Note: This is a fully remote role with Central time (CST) working hours along with 10% travel. 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.

Position Purpose: Within the Illinois Health Plan, the Provider Data Manager leads inventory, quality, production, and employee development while ensuring accountability, operational excellence, and a culture of trust. They partner across departments, drive process and system improvements, and leverage dashboards and data-driven insights to enhance efficiency, decision-making, and organizational outcomes. The Manager Provider Data Management is responsible for managing the activities that support all provider data management projects, policies and procedures, along with provider contract setup activities, key initiatives that relate to operational issues for provider data maintenance, key initiatives that support successful claims adjudication, directory accuracy as well as other operational projects that support internal departments. Works in conjunction with Credentialing for the set up and maintenance of all delegated entity arrangements. Responsible for overseeing the development of reports to support the strategic and operational requirements of the department.

• Identifies and implements value-added programs and initiatives that support and enhance network contracting to achieve operational efficiency.
• Acts as main contact for internal departments on projects that require changes to business applications (provider, contracts, and claims) on the system.
• Meets with internal departments to identify project requirements and ensure satisfactory project completion.
• Works with Information Systems Department on special projects.
• Supervises staff and directs and monitors the staff activity.

• Conducts reviews, one on ones and provides monthly statistics to staff on their performance.

• Ensures staff is meeting both quality and production scores.

• Turnaround times for production standards should also be carefully monitored and reported.

• Maintains detailed understanding and working knowledge of business applications specifically provider data management, provider reimbursement, and claims processing on the system.
• Develops cost benefit analysis for projects to assist in prioritization and project justification.
• Works with other internal departments in the development of such policies and procedures and updates such policies and procedures in manual and training as needed.
• Heads meetings to discuss and communicate new business workflows and new policies and procedures.
• Conducts training for both internal and external departments on provider data services policies and procedures.
• Resolves issues within internal departments related to interpretation of contracts or policies.

• Defines reporting and information initiatives with internal and external customers to support strategic and operational requirements.

• Performs ad-hoc reporting as necessary to meet strategic and operational requirements.

• Maintains provider data integrity guidelines for delegated credentialing vendors.

• Prioritizes data analysis projects based on business needs.

• Designs and develops workflows, protocols, and process models for use with standard and ad-hoc reports.

• Maintains, tests, and revises current data analysis programs.

• Manages input data from various internal and external sources.

• Performs other duties as assigned.
• Complies with all policies and standards.

Preferred Skills:

Strong history of leadership roles with direct reports.

Proficient in Microsoft Office Suite, especially Excel, Visio, and Word.

Good communication and meeting facilitation skills.

Knowledge and experience working with Portico, Amisys, Directory, and other provider-related systems.

Required Education/Experience:

Bachelor’s degree required for this role in business administration, Health Care, or a related field.

1-3 years management experience in a business setting required.

Minimum (3) years' experience working in a health care setting, preferably with a background in provider relations, provider data services, information technology or claims operations. Experience developing new business processes and procedures.

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