Centene

1 month ago

Senior Compliance Administrator, Medicare Claims & Payment Integrity

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 4 hours agoStatus: Live

Job Summary

Support the Medicare Compliance Advisory program by interpreting CMS regulations, advising leadership, and ensuring alignment with CMS and federal/state requirements. Drive evidence-based issue tracking, risk assessment, and corrective actions across cross-functional teams while contributing to audit readiness and program improvement in a regulated healthcare environment.

Location: Missouri, Illinois, Florida

Workplace: Remote

Employment Type: Full time

Job Function: Administration & Executive Assistance

Key Responsibilities

•Execute the Medicare Compliance Program in alignment with CMS and applicable federal and state regulations, ensuring prevention, detection, and correction of noncompliance and FWA.
•Serve as a compliance advisor and subject matter resource for Medicare programs by interpreting CMS regulations and guidance and translating requirements into clear, actionable business input; advise leadership on compliance impact and implementation needs.
•Conduct regulatory research and analysis to support business inquiries, compliance advisory opinions, and implementation activities.
•Support intake, tracking, and resolution of compliance issues, including documenting findings, assessing risk, and recommending corrective actions.
•Maintain accurate and complete documentation of compliance activities, including issue logs, regulatory references, self-disclosures and supporting evidence.

Pay and Benefits

Perks:Health Insurance401kEquityPaid LeaveRemote Work

Key Requirements

•Bachelor’s degree in a related field (e.g., healthcare administration, public health, policy) or equivalent experience required. Master’s Degree or Juris Doctor preferred.
•5+ years Compliance, regulatory, operations, or risk management within a regulated industry (e.g., healthcare, managed care, insurance, or public sector).
•Demonstrated experience interpreting and applying complex regulatory frameworks and compliance program requirements within a regulated environment into clear, actionable guidance for business stakeholders.
•Experience leading cross-functional initiatives or large-scale compliance efforts.
•Certified in Healthcare Compliance (CHC) preferred; RN, LPN, Pharmacist, CPhT, Case Management preferred.

Experience:HealthcareMedicareManaged care

Education:Bachelor's

Skills:CommunicationCollaborationProblem-solvingStakeholder managementLeadership

Certifications:Certified in Healthcare Compliance (CHC)

Company Brief

Centene

Centene Corporation is a diversified, multinational healthcare enterprise that provides government-sponsored and commercial healthcare programs and services, specializing in Medicaid, Medicare, and specialty benefits management across the United States.

Industry: Health Insurance (Payers)

Company Size: Enterprise (1,001+ employees)

Revenue: USD 1B+

Growth: Public Company

Valuation: Public Company (Market Cap in USD)

Funding: IPO / Publicly Listed

Headquarters: St. Louis, United States

Founded: 1984

Website LinkedIn

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Centene

1 month ago

Senior Compliance Administrator, Medicare Claims & Payment Integrity

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 4 hours agoStatus: Live

Job Summary

Location: Missouri, Illinois, Florida

Workplace: Remote

Employment Type: Full time

Job Function: Administration & Executive Assistance

Key Responsibilities

•Execute the Medicare Compliance Program in alignment with CMS and applicable federal and state regulations, ensuring prevention, detection, and correction of noncompliance and FWA.
•Serve as a compliance advisor and subject matter resource for Medicare programs by interpreting CMS regulations and guidance and translating requirements into clear, actionable business input; advise leadership on compliance impact and implementation needs.
•Conduct regulatory research and analysis to support business inquiries, compliance advisory opinions, and implementation activities.
•Support intake, tracking, and resolution of compliance issues, including documenting findings, assessing risk, and recommending corrective actions.
•Maintain accurate and complete documentation of compliance activities, including issue logs, regulatory references, self-disclosures and supporting evidence.

Pay and Benefits

Perks:Health Insurance401kEquityPaid LeaveRemote Work

Key Requirements

•Bachelor’s degree in a related field (e.g., healthcare administration, public health, policy) or equivalent experience required. Master’s Degree or Juris Doctor preferred.
•5+ years Compliance, regulatory, operations, or risk management within a regulated industry (e.g., healthcare, managed care, insurance, or public sector).
•Demonstrated experience interpreting and applying complex regulatory frameworks and compliance program requirements within a regulated environment into clear, actionable guidance for business stakeholders.
•Experience leading cross-functional initiatives or large-scale compliance efforts.
•Certified in Healthcare Compliance (CHC) preferred; RN, LPN, Pharmacist, CPhT, Case Management preferred.

Experience:HealthcareMedicareManaged care

Education:Bachelor's

Skills:CommunicationCollaborationProblem-solvingStakeholder managementLeadership

Certifications:Certified in Healthcare Compliance (CHC)

Company Brief

Centene

Industry: Health Insurance (Payers)

Company Size: Enterprise (1,001+ employees)

Revenue: USD 1B+

Growth: Public Company

Valuation: Public Company (Market Cap in USD)

Funding: IPO / Publicly Listed

Headquarters: St. Louis, United States

Founded: 1984

Website LinkedIn