Senior Manager, Payment Integrity- Recovery Operations

📋 Description

• • Centene Corporation is seeking a highly motivated and experienced Senior Manager, Payment Integrity- Recovery Operations to join our dynamic team. In this pivotal role, you will be instrumental in transforming the health of our communities by ensuring the integrity of our payment recovery processes. You will provide critical oversight of post-claims recovery execution, guaranteeing that all potential recoveries are fully realized through meticulous reconciliation, proactive exception resolution, and robust oversight of our recovery systems. This position demands a sharp operational focus to prevent any loss, delay, or misplacement of recovery funds, ensuring that all recovery outcomes are not only accurate and complete but also fully prepared for any audit.
• • As the Senior Manager, you will own the end-to-end process of post-recovery execution, establishing and maintaining rigorous standards to ensure that all recovery activities are completed with the utmost accuracy and within established timelines. Your responsibility extends to maintaining comprehensive visibility and control over the entire recovery inventory. This includes diligent management of rolling balances, tracking recoveries that are in progress, and meticulously documenting completed recoveries. This granular oversight is crucial for identifying trends, potential bottlenecks, and opportunities for process improvement.
• • A core function of this role involves performing detailed financial reconciliations. You will be tasked with confirming that all recovered amounts are fully realized and accurately reflected across all relevant financial systems. This requires a deep understanding of financial reporting and reconciliation procedures, ensuring the integrity of our financial data.
• • You will be at the forefront of identifying and investigating any instances of recovery drops, failures, or anomalies. Your analytical skills will be critical in pinpointing the root causes of these issues and implementing corrective actions to prevent the loss or delay of recovery dollars. This proactive approach is key to maximizing financial recovery and minimizing financial leakage.
• • Leading the resolution of recovery exceptions will be a significant part of your role. This involves coordinating with various internal teams, managing the lifecycle of exception tickets from identification through to closure, and ensuring that all issues are addressed efficiently and effectively. Your ability to collaborate and drive resolution will be paramount.
• • You will serve as a key liaison, escalating and resolving systemic recovery issues. This requires close partnership with critical departments such as Claims, Finance, Configuration, and Technology teams. By fostering strong cross-functional relationships, you will ensure that underlying system or process issues are addressed comprehensively, preventing recurrence and improving overall operational efficiency.
• • As the business subject matter expert for recovery systems, you will possess a deep understanding of platforms like the Claims Recovery Platform and coordinate effectively with the Enterprise Business Operations System. Your expertise will guide the strategic use and optimization of these tools.
• • Continuous monitoring of recovery execution is essential. You will closely track performance against key metrics to ensure strict compliance with all regulations and internal policies, maintain high levels of accuracy, and guarantee that all recovery operations are audit-ready at all times. This vigilance is crucial for maintaining the company's reputation and financial health.
• • This role also involves performing other duties as assigned, demonstrating flexibility and a willingness to contribute to broader team objectives. You will be expected to comply with all company policies and standards, upholding the highest levels of professional conduct and operational integrity. Your leadership will directly impact the financial health of the organization and the effective delivery of services to our 28 million members.