Vice President II, Configuration Operations at Centene

Ideal for a seasoned leader with at least 10 years of experience in healthcare or managed care who holds a Bachelor’s degree. You are an expert in claims adjudi

Work type: remote

Location: Remote-MO | Remote-FL

Salary: $227,700 – $431,400/yr

Type: Full-time

Summary

Ideal for a seasoned leader with at least 10 years of experience in healthcare or managed care who holds a Bachelor’s degree. You are an expert in claims adjudication, benefit configuration, and provider pricing systems within the insurance sector. **What makes it worth a look...** Centene offers a highly competitive salary range of $227,700 to $431,400 per year for this fully remote position. You will also have access to comprehensive benefits including 401K plans and stock purchase options. **You might be a good fit if you...** * Have deep expertise in claims configuration platforms and provider pricing logic. * Understand regulatory compliance requirements for CMS, Medicaid, and Marketplace programs. * Possess a track record of driving system readiness and reducing claims payment errors. * Can lead large-scale configuration teams in a complex, multi-platform environment.

Job Description

Centene is transforming the health of our communities one person at a time.  As an Executive on our team, you could be the one who changes everything for our 28 million members.
 

Position Purpose:

Provides enterprise leadership and strategic oversight for benefit and provider payment configuration that supports accurate claims adjudication, benefit administration, and provider pricing across Medicare, Medicaid, and Marketplace lines of business and multiple platforms. This role ensures claims configuration, authorization and payment requirements, benefit rules, pricing logic, and system alignment collectively enable compliant, efficient, and scalable claims processing.

Aligns operational execution with regulatory requirements, financial integrity, and enterprise strategy. The position is accountable for driving configuration excellence, ensuring system readiness to support evolving regulatory and business needs, and enabling operational performance that supports accurate, timely, and compliant claims outcomes.

• Establish and execute the enterprise strategy for claims configuration operations, including benefit configuration, authorization payment logic, and provider pricing.

• Serve as the accountable business owner for claims configuration platforms and pricing systems.

• Ensure configuration complies with CMS, state Medicaid agencies, Marketplace requirements, and contractual obligations.

• Drive continuous improvement to reduce claims payment errors and rework.

• Lead and develop high-performing configuration operations teams.

• Performs other duties as assigned.

• Complies with all policies and standards.

• Bachelor's Degree in Business Administration, Healthcare Administration, Information Systems or related field required.

• Master's Degree preferred.

• 10+ years of progressive leadership experience in healthcare, managed care, or health insurance operations including claims adjudication systems, benefit configuration, and provider pricing required.

• Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

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.

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