Sr. Manager Payment Integrity - Health Plan Concierge

Centene
Missouri, Florida, Texas
Workplace: RemoteFull timeUSD 107,700 - 199,300 annuallyFunction: Hospitality & Food ServiceExperience: 6+ yearsEducation: bachelorsSkills: ["Communication","Relationship management","Leadership","Cross-functional collaboration","Analytics"]

Provide strategic leadership for the Health Plan Concierge Payment Integrity vertical, overseeing market engagement, provider alignment, escalation management, and cross-functional coordination. Lead teams to reduce improper payments, enhance claims accuracy, and translate experience signals into actionable priorities using governance, controls, and performance measures. Partner with Claims, Clinical, Finance, Compliance, Provider Relations, Network, Legal, and IT to resolve systemic issues, drive provider education, and present performance and savings outcomes to support enterprise objectives.

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Centene
Centene
3 days ago

Sr. Manager Payment Integrity - Health Plan Concierge

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Job Summary

Provide strategic leadership for the Health Plan Concierge Payment Integrity vertical, overseeing market engagement, provider alignment, escalation management, and cross-functional coordination. Lead teams to reduce improper payments, enhance claims accuracy, and translate experience signals into actionable priorities using governance, controls, and performance measures. Partner with Claims, Clinical, Finance, Compliance, Provider Relations, Network, Legal, and IT to resolve systemic issues, drive provider education, and present performance and savings outcomes to support enterprise objectives.
Location: Missouri, Florida, Texas
Workplace: Remote
Employment Type: Full time
Job Function: Hospitality & Food Service
Seniority: Sr. Manager level

Key Responsibilities

  • •Provide operational and strategic leadership for Payment Integrity activities within an assigned line of business to support market-facing provider engagement and issue resolution.
  • •Execute program strategies to reduce improper payments, enhance claims accuracy, and meet financial and operational objectives aligned to enterprise Payment Integrity goals.
  • •Implement and maintain governance processes, controls, documentation standards, and performance measures to uphold accuracy, compliance, and operational integrity.
  • •Collaborate with cross-functional partners to address systemic issues, resolve escalations, improve workflows, and enhance provider and member experience.
  • •Lead provider education and communication tied to PI edits, audits, policies, and process changes; oversee complex provider issue resolution and present performance and risk mitigation outcomes.

Pay and Benefits

Salary: USD 107,700 - 199,300 annually
Perks:Health Insurance401kEquityPaid LeaveRemote Work

Key Requirements

  • •6+ years of experience in Payment Integrity, claims operations, reimbursement methodologies, or managed care operations within a complex health plan.
  • •4+ years of leadership experience with direct reports.
  • •3+ years of Payment Integrity functions (pre-pay edits, post-pay audits, analytics, or fraud/waste/abuse programs).
  • •Experience managing escalated issues with senior leaders and working cross-functionally with Network, Claims, Clinical, Legal, Compliance, IT, Finance, and Health Plan teams.
  • •Bachelor’s degree in Healthcare Administration, Business, Public Health, Health Information Management, or a related field (or equivalent work experience); Master’s preferred.
Experience:6+ yearsManaged care
Education:Bachelor's
Skills:CommunicationRelationship managementLeadershipCross-functional collaborationAnalytics

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