Manager, Payment Integrity Insights & Innovation

Centene
Missouri
Workplace: RemoteFull timeUSD 87,700 - 157,800 annuallyFunction: OtherExperience: 4+ yearsEducation: bachelorsSkills: ["Leadership","Investigation","Compliance","Communication","Analytical thinking"]

Lead strategic fraud, waste, and abuse (FWA) activities by managing state and federal requirements and monitoring billing/claims payment integrity. Oversee investigations of referrals by leading teams of analysts, develop tailored fraud plans, and create educational materials to identify waste activities. Respond to RFPs, implement policy changes, present FWA programs to state/federal personnel, and manage refund reviews. Produce monthly/quarterly savings reporting and ensure compliance.

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Centene
Centene
1 day ago

Manager, Payment Integrity Insights & Innovation

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Last checked: 2 hours agoStatus: Live

Job Summary

Lead strategic fraud, waste, and abuse (FWA) activities by managing state and federal requirements and monitoring billing/claims payment integrity. Oversee investigations of referrals by leading teams of analysts, develop tailored fraud plans, and create educational materials to identify waste activities. Respond to RFPs, implement policy changes, present FWA programs to state/federal personnel, and manage refund reviews. Produce monthly/quarterly savings reporting and ensure compliance.
Location: Missouri
Workplace: Remote
Employment Type: Full time
Seniority: Manager level

Key Responsibilities

  • •Develop, implement, and manage strategic fraud, waste, and abuse activities while maintaining state and federal requirements.
  • •Monitor business processes and systems to ensure integrity and compliance in billing and claims payment.
  • •Lead teams of analysts to investigate fraud, waste, and abuse referrals.
  • •Develop customized fraud plans, educational materials, and present the FWA program to state/federal personnel as required.
  • •Review post-payment cases for refunds and prepare monthly and quarterly savings reports.

Pay and Benefits

Salary: USD 87,700 - 157,800 annually
Perks:Health Insurance401kPaid LeaveEquity

Key Requirements

  • •Bachelor’s degree in Business, Healthcare, Criminal Justice (or related field) or equivalent experience.
  • •4+ years of medical claim investigation, compliance, or fraud and abuse experience.
  • •Thorough knowledge of medical terminology.
  • •Previous managed care experience and experience leading or supervising staff (hiring, training, assigning work, managing performance).
  • •Medical records or coding license preferred.
Experience:4+ yearsManaged care
Education:Bachelor's in Business, Healthcare, Criminal Justice, or related field
Skills:LeadershipInvestigationComplianceCommunicationAnalytical thinking
Licenses:Medical records licenseCoding license

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
WebsiteLinkedIn