**Who this is for** This role is for an experienced manager passionate about ensuring the integrity of healthcare payments and preventing fraud, waste, and abus
Work type: remote
Location: Remote-MO | Remote-TX | Remote-FL | Remote-CA
Salary: $87,700 – $157,800/yr
Type: Full-time
**Who this is for** This role is for an experienced manager passionate about ensuring the integrity of healthcare payments and preventing fraud, waste, and abuse. If you have a background in medical claims investigation, compliance, or fraud detection and enjoy leading teams to uphold state and federal requirements, this fully remote position at Centene is ideal. **Key highlights** As the Manager, Payment Integrity Governance, you will develop and implement strategic fraud, waste, and abuse activities. This involves monitoring business processes, leading investigations, developing fraud plans, and preparing reports on savings, all while ensuring compliance with contractual obligations. **You might be a good fit if you...** - Hold a Bachelor's degree in Business, Healthcare, Criminal Justice, or a related field, with 4+ years of experience in medical claim investigation, compliance, or fraud and abuse. - Have thorough knowledge of medical terminology and experience in a managed care environment. - Can lead teams of analysts in investigating fraud, waste, and abuse referrals. - Are proficient in developing customized fraud plans and creating educational materials on waste activities.
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: Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends/schemes
License/Certification: Medical records or coding license preferred.
Pay Range: $87,700.00 - $157,800.00 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.