You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
- Manage compliance with all Federal and State Laws and Regulations related to program integrity and disclosure requirements. Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends and schemes.Safeguard against the potential for fraud, waste and abuse and coordinate with, the Special Investigations Unit and state agencies to promptly investigate reports of, suspected fraud and abuse by employees, subcontractors, providers, and others with whom the health plan does business
- Serve as the health plan’s primary fraud, waste and abuse subject matter expert
- Coordinate audit documentation, develop internal and state required reports and internal policies and procedures
- Arrange, conduct and attend the health plan’s fraud, waste and abuse work groups and participate in other various committees
- Act as the primary liaison with the State to ensure assure coordination efforts with state agencies concerning program integrity issues
- Bachelor’s degree in Business, Healthcare, Criminal Justice, related field, or equivalent experience.
- 4+ years of combined medical claim investigation, financial impact analysis, business analysis, compliance or fraud and abuse experience.
- Thorough knowledge of medical terminology.
- Previous experience in managed care environment and as a lead or supervisor of staff, including hiring, training, assigning work and managing performance preferred.
- Knowledge of Microsoft Excel, medical coding, claims processing, and data mining preferred.
Our Comprehensive Benefits Package:
- Flexible work solutions including remote options, hybrid work schedules and dress flexibility
- Competitive pay
- Paid Time Off including paid holidays
- Health insurance coverage for you and 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.