Centene is dedicated to advancing initiatives that focus on inclusion, the whole person, and community development by investing in institutions and organizations that help build vibrant and healthy communities.

Product Manager, Commercial Products

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.

Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States.

Position Purpose: Ensure successful execution, maintenance, and improvement of Centene’s products. Manage a specific product (e.g. Value, Virtual, etc.) and support issues that arise in the current plan year while also building the vision and strategy for future years. Drive execution of the strategy to implementation with a cross-functional team.

• Own and drive resolution for in-year issues identified where the product is not operating/performing as expected.
• Support definition and execution of product roadmaps, and drive near and long-term strategies that increase product value over time.
• Track performance of the individual product assigned (market, financial, operational) and collaborate with cross-functional partners to mitigate performance risks across functional verticals (e.g. Rx, Network, Risk Adjustment).
• Serve as subject matter expert to internal and external stakeholders on products and provide proactive communication to applicable cross-functional partners, health plans, and executive leadership team.

Education/Experience: Bachelor’s degree in Business Administration, Marketing and Sales, or related field, or equivalent experience. 4+ years of experience managing healthcare products and/or managed care, including but not limited to health plan, provider, or health system experience. Experience driving product implementations, managing product operational performance preferred. Product concept development is preferred. Clinical experience and/or certification (i.e., RN, LCSW, PA, etc.) or 2-4 years equivalent experience is highly preferred. Experience using Power BI is highly preferred. Experience using PowerPoint and Excel is preferred.

Pay Range: $84,300.00 – $151,700.00 per year

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. Total compensation may also include additional forms of incentives.

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

Senior Actuary – Risk Adjustment

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: This Senior Actuary will serve as the primary Risk Adjustment contact for 5 to 6 Medicaid markets.

In this Senior Actuary role, you will:

• Be accountable for ensuring timely and accurate updates to Risk Adjustment Initiative Revenue and Expense for forecasting.
• Lead data driven analyses that drive change to programs and improve outcomes for our members.
• Responsible for overseeing portfolio of Medicaid Risk Adjustment initiatives and supporting our Markets and other Shared Services teams.
• Have no direct reports, but will have access to pool of actuarial and data analysts / scientists on the Risk Adjustment team.
• Ensure all data submissions to the state are complete and that all diagnosis codes received by Centene flow end to end.
• Maintain a culture of compliance for the Medicaid risk adjustment programs in their markets.
• Strengthen reporting and visibility of Risk Adjustment outcomes throughout Markets and Senior leadership team.
• Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes.

Why is this role appealing: While this Senior Actuary position focuses directly on Medicaid, you will collaborate closely with actuaries working on various markets and lines of business. This will enable you to learn from broader team discussions about what strategies are working and which ones are not.

Preferred, yet not required experience: Experience with risk adjustment for other government-sponsored insurance products, including Medicaid markets utilizing different models, or experience with general Medicaid rate setting, forecasting, or analysis would be considered a positive.

Education/Experience:

• Bachelor’s degree in Business or related field.
• 7+ years of actuarial experience and Associate in Society of Actuaries (ASA) certification
• Or, 5+ years of actuarial experience and Fellow in Society of Actuaries (FSA) certification.

License/Certification: Fellow or Associate in Society of Actuaries (or equivalent international certification); Member of American Academy of Actuaries (or equivalent international membership).

Preferred technical skills: Any combination of SAS, SQL, or Teradata experience

Medicare Sales Representative

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 sales coverage and develop best possible market penetration for all products to present and prospective accounts in his/her assigned territory in accordance with company’s policies and programs. Provide greater access to health insurance, by providing education and assistance to Medicare individuals. Distribute health education materials and arrange for health screenings. Provide Facilitated Enrollment, help facilitate the continuance of health insurance, and offer assistance with recertification.

• Identify prospective enrollees and determine eligibility for participation in the Advantage Medicare product

• Understand and apply all policies and procedures pertaining to:

• Disclosures and provisions of the Advantage Medicare product

• Enrollment and disenrollment

• Develop a presence in the local community to help generate enrollments

• Conduct home visits and personalized appointments as needed to complete the enrollment process

• Market Advantage on-site at hospitals, senior centers, assisted living facilities, community events and other sites as designated

• Understand the covered benefits, non-covered benefits, exclusions and exemptions

• Assist members in accessing health care, transportation needs and other services or issues as they occur and pertain to members

• Keep informed and adhere to current information pertaining to marketing activity guidelines set forth by various regulatory agencies—this includes providing enrollees with all corresponding materials and documentation

• Keep alert to competitive products and marketing practices, and to keep management informed concerning them

• Conduct and participate in telemarketing/outreach efforts as required

• Attend and participate in sales meetings, training programs, conventions, and special events

• Complete applications in a timely and accurate manner

• Submit special reports regarding the operation of the territory, acceptance or rejection of products, and competitive conditions beneficial to other Marketing representatives and company operations
• Performs other duties as assigned

• Complies with all policies and standards

90% Field Based travel in Atlanta, GA and 10% office/hub.

Care Management Support Coordinator II

Supports administrative care management activities including performing outreach, answering inbound calls, and scheduling services. Serves as a point of contact to members, providers, and staff to resolve issues and documents member records in accordance with current state and regulatory guidelines.

• Provides outreach to members via phone to support with care plan next steps, community or health plan resources, questions or concerns related to scheduling and ongoing education for both the member and provider throughout care/service
• Provides support to members to connect them to other health plan and community resources to ensure they are receiving high-quality customer care/service
• May apply working knowledge of assigned health plan(s) activities and resources
• Serves as the front-line support on various member and/or provider inquiries, requests, or concerns which may include explaining care plan procedures, and protocols
• Supports member onboarding and day-to-day administrative duties including sending out welcome letters, related correspondence, and program educational materials to assist in the facilitation of a successful member/provider relationship
• Documents and maintains non-clinical member records to ensure standards of practice and policies are in accordance with state and regulatory requirements and provide to providers as needed
• Knowledge of existing benefits and resources locally and make referrals to address Social Determinants of Health (SDOH) needs
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience:
Requires a High School diploma or GED
Requires 1 – 2 years of related experience