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: Provides strategic leadership across the Health Plan Concierge vertical, overseeing market engagement, provider alignment, escalation management, and cross-functional coordination. Leads teams that address provider and market needs, resolves issues effectively, and ensures market insights inform Payment Integrity priorities. Directs forums and taskforces that translate experience signals into actionable priorities, supporting claims accuracy, reduced improper payments, and improved financial performance. Partners with business, clinical, legal, compliance, technology, and network leaders to deliver effective provider education, strengthen governance, and drive adoption of initiatives that support sustainable medical cost savings and enterprise operational excellence. - Provides operational and strategic leadership for Payment Integrity activities within an assigned line of business, supporting market-facing efforts such as provider engagement, issue resolution, escalation management, communications and cross-functional coordination. - Executes program strategies that reduce improper payments, enhance claims accuracy, and support financial and operational objectives for the assigned business segment, ensuring alignment with broader enterprise PI goals. - Implements and maintains governance processes, controls, documentation standards, and performance measures that uphold accuracy, compliance, and operational integrity within the line of business. - Collaborates with partners across Claims, Clinical, Finance, Compliance, Provider Relations, Network, Legal, IT, and Health Plan teams to address systemic issues, resolve escalations, improve workflows, and enhance provider and member experience. - Leads insight-generation and analytics activities for the assigned line of business identifying provider pain points, operational risks, emerging trends, and opportunities to improve payment accuracy and prevent issue. - Directs provider education and communication efforts by delivering clear, consistent messaging tied to PI edits, audits, policies, and process changes and supporting successful adoption across internal and external stakeholders. - Oversees activities related to resolving complex provider issues, including coordinating supporting documentation, clarifying program requirements, and collaborating with internal partners to ensure timely and accurate case management. - Ensures compliance with CMS, Medicaid, Medicare, state regulatory requirements, coding and documentation standards, and all applicable policies, applying enterprise guidance to the unique needs of the assigned line of business. - Presents program performance, provider issue themes, savings outcomes, and risk mitigation strategies to inform prioritization, governance decisions and organizational planning. - Performs other duties as assigned. - Complies with all policies and standards. Education/Experience: Education - Bachelor’s degree in Healthcare Administration, Business, Public Health, Health Information Management, or related field or equivalent work experience, required. - Master’s degree preferred. - 6+ years of experience in Payment Integrity, claims operations, reimbursement methodologies, or managed care operations within a complex health plan, multi-line payer. - 4+ years of experience of leadership experience with direct reports - 3+ Experience with PI functions such as pre-pay edits, post-pay audits, analytics, or fraud/waste/abuse functions programs - 2+ years of managing escalated issues with Senior Leaders - Experience working with cross-functionally with Network, Claims, Clinical, Legal, Compliance, IT, Finance, and Health Plan leadership to resolve provider or market challenges. - Experience leading provider-facing work, including communications, education, disputes, or external stakeholder engagement. - Strong understanding of payment integrity concepts, reimbursement methodologies, provider workflows, and regulatory requirements relevant to the applicable line of business. - Ability to use analytics and insights to identify trends, diagnose root cause, and drive operational and improvement. - Strong communication and relationship management skills with the ability to translate complex PI programs into clear guidance for internal and external audiences. - Ability to influence across a matrixed environment and effectively communicate risk, compliance considerations, and operational impacts to expectations to leadership. - Experience with Medicaid and/or Medicare managed care requirements and regulatory expectations, preferred. Pay Range: $107,700.00 - $199,300.00 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, 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

• Consults with staff at all levels in the organization, including department heads and project team leaders to provide support in identifying and achieving positive outcomes for the organization. • Analyzes existing business processes, identifying areas for improvement, and implementing strategies to enhance efficiency, reduce costs, and optimize overall performance. • Develops Lean Performance Improvement capabilities through the delivery of education and training for all staff and faculty as required. • Applies cutting-edge customer service and consulting skills to drive initiatives throughout the organization. • Provides consulting services that support strategic plans to improve patient care and control costs. • Conceptualizes and develops Lean Performance Improvement capabilities and strategies within the assigned value stream. • Facilitates the implementation of initiatives to benefit the organization and achieve negotiated customer outcomes. • Supports and facilitates Targeted Improvement Efforts (TIEs) through defining the problem, gathering data, and successful implementation of tools. • Collaborates with Lean Practitioners in developing appropriate measures and metrics for capturing lean benefits using appropriate methodology throughout the tools and techniques to achieve operational improvement. • Supports the development of new initiatives, such as organization-wide customer service, communication processes and re-engineering. • Formulates, manages, administers, interprets and coordinates work processes related to the implementation, administration, presentation and evaluation of education.

• Support and execute key internal processes that keep our organization running smoothly. • Maintain established systems, ensuring operational consistency and supporting cross-team coordination. • Serve as the operational backbone for internal people systems and organizational workflows. • Ensure consistent execution, accuracy, and follow-through across core administrative processes.

TPA Transportation Supervisor Department: Claims Administration & Adjusting Employment Type: Permanent - Full Time Location: Home United States Reporting To: Kenneth Krause Compensation: $80,000 - $95,000 / year Description Our Story Imagine being part of a team that’s not just shaping the future but actively driving it. At Davies North America, we’re at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors. Davies North America has an immediate opening for an experienced insurance professional with the ability to supervise adjusters, handling, but not limited to - collision, comprehensive and property damage liability auto claims. This position will support our Third-Party Administration (TPA) claims Transportation Division. The candidate displays a strong work ethic and can successfully work independently. The ideal candidate will be highly adaptable in a fast paced, result driven environment. This is a remote, work from home position. Key Responsibilities - Previous experience handling or supervising Collision, Comprehensive and PD claims involving personal auto - Ability to work in a fast-paced work environment - Assures compliance with Davies and client claim handling guidelines - Review insurance policies and determine coverage - Determine liability and defenses - Provide claim summaries and participate in routine file reviews with clients - Identify claim trends and participate in client audit reviews - Monitor team performance and mentor team members for future career opportunities - Provides support, guidance, leadership, and motivation to promote maximum performance - Perform other duties as assigned Skills, knowledge & expertise - 5-7 years of industry experience - 2 years of supervisory or management experience - Excellent verbal and written communication, including presentation skills - Strong interpersonal skills - Critical thinking and analytical skills - Able to work in team environment as well as independently - Strong organizational skills - Leadership/Management/Motivational Skills Required Education and Experience: - Texas All-Lines Adjuster License - Florida License required or must be attainable - Proficient in use of Microsoft Office Suite software and other business-related software Benefits Benefits At Davies North America, we are dedicated to supporting the well-being and future of our qualifying employees. Our comprehensive benefits package includes: - Medical, dental, and vision plans to ensure your health and that of your family. - A 401k plan with employer matching to help you build a secure financial future. - Our time-off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment. - Paid holidays. - Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones. Massachusetts Notice It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. Diversity and Inclusion Davies is dedicated to fostering a diverse and inclusive workplace that embraces a wide range of perspectives and experiences. We believe that diversity of thought is essential for innovation and creativity, and we actively promote an environment where all voices are valued and heard. Compensation Transparency: The salary range listed reflects the full compensation band for this role across all locations. Actual compensation will be based on factors such as skills, experience, qualifications, and geographic location, which may impact the final offer. We share ranges to remain transparent and consistent with pay equity practices. We do not use sites like Facebook, Craigslist, or Telegram to recruit or interview potential employees or contractors. If you have been asked to provide any information through any method other than our career portal, please email us at recruitment@davies-group.com