Job Location: Saint Louis, MO
You could be the one who changes everything for our 26 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*
Position Purpose: Develop business insights through use of UI Path process mining investigating activities spanning the end-to-end claim lifecycle, from incoming EDI or paper claims through to rejection, denial, or payment and the associated fulfillment processes. Use analytics tools investigating activities managed in on premises and cloud-based business process automation tools (e.g. Pegasys, SFDC, AWS).
Identify factors leading to adjustments and associated reasons. Package insights for use by process architects, continuous improvement, product owners, and claims operations to drive short term and long-term efficiency gains. Partner with Workflow & Intelligent Automation Analyst to provide a complete picture of work flowing through clinical operations systems, Edifecs, core claims systems, surround code, membership systems, medical management systems, on-prem workflow, and cloud and workflow environments. Partner with Data Science Team to establish data sources with consistent meaning across multiple system and process ecosystems. This role is accountable to lead the support of claims process architecture business initiatives through data analysis, identification of implementation barriers and insights drawn from various systems.
Lead the support of claims process architecture business initiatives
Lead the support of claims process architecture business initiatives through data analysis, identification of implementation barriers and insights drawn from process mining various systems, using a thorough understanding of claims systems and surrounding reports, extraction and manipulation of data to identify gaps in process.
Resolve issues and identify opportunities for process redesign and improvement.
Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations, including improvements and revisions to business processes and requirements. Evaluate risks and concerns and communicate to process architects and management.
Develop, share, and incorporate organizational best practices into business applications.
Serve as the subject matter expert on the process mining environment, establishing capability to draw insights from real world transactional flows through relevant systems.
Ability to travel up to 20%
Education/Experience:
Bachelor’s degree in related field or equivalent experience. MSBA or MBA desirable. 6+ years of business process or data analysis preferably in healthcare including business process definition and documentation and agile development, preferably in healthcare working in a data driven environment. Advanced knowledge of process mining (Celonis, Process Gold, UI Path Process Mining, or UI Path Task Mining) highly preferred. Advanced knowledge of Microsoft Applications, including Excel, Visio, and SharePoint required. Intermediate knowledge of workflow tools as sources for analytics highly preferred. Knowledge of managed care information or claims payment systems or knowledge of Amisys or other claims system, HIPAA transactions (i.e. 837, 999, 824, 277) and SQL Scripting preferred.
Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, 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.
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.
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