Manager, Payment Integrity - Intake & Demand

Centene
Missouri, Georgia, Texas, Illinois, Florida
Workplace: RemoteFull timeUSD 87,700 - 157,800 annuallyFunction: Legal, Risk & ComplianceExperience: 4+ yearsEducation: bachelorsSkills: []

Develop and manage fraud, waste, and abuse strategies by monitoring billing and claims payment processes for integrity and compliance with state and federal requirements. Lead a team of analysts to investigate referrals, build customized fraud plans, and produce educational materials. Manage RFP-driven policy updates, prepare and present the FWA program for state/federal personnel, and review post-payment cases to obtain refunds.

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Centene
Centene
1 day ago

Manager, Payment Integrity - Intake & Demand

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Source: Company careers pageValidated by: Fursa AI
Last checked: 11 hours agoStatus: Live

Job Summary

Develop and manage fraud, waste, and abuse strategies by monitoring billing and claims payment processes for integrity and compliance with state and federal requirements. Lead a team of analysts to investigate referrals, build customized fraud plans, and produce educational materials. Manage RFP-driven policy updates, prepare and present the FWA program for state/federal personnel, and review post-payment cases to obtain refunds.
Location: Missouri, Georgia, Texas, Illinois, Florida
Workplace: Remote
Employment Type: Full time
Job Function: Legal, Risk & Compliance
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 assure integrity and compliance in billing and claims payment.
  • •Lead teams of analysts to investigate fraud, waste, and abuse referrals appropriately.
  • •Develop customized fraud plans, create educational materials to identify/validate waste activities, and prepare monthly and quarterly saving reports.
  • •Prepare and present the FWA program for state/federal personnel, respond to RFP requests with new policies, and review post-payment cases to obtain refunds.

Pay and Benefits

Salary: USD 87,700 - 157,800 annually
Perks:Health Insurance401kPaid LeavePaid HolidaysRemote Work

Key Requirements

  • •Bachelor’s degree in Business, Healthcare, Criminal Justice, related field, or equivalent experience.
  • •4+ years of medical claim investigation, compliance, or fraud and abuse experience.
  • •Thorough knowledge of medical terminology required.
  • •Experience in a managed care environment, including lead or supervisor experience (hiring, training, assigning work, and managing performance).
  • •Medical records or coding license preferred.
Experience:4+ yearsHealthcareManaged care
Education:Bachelor's in Business, Healthcare, Criminal Justice
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