Lead SIU Investigator

Centene
Missouri, Idaho, Arizona, Washington, Colorado, Texas, Nevada, California
Workplace: RemoteFull timeUSD 70,100 - 126,200 annuallyFunction: Administration & Executive AssistanceExperience: 5+ yearsEducation: bachelorsSkills: ["Risk assessment","Investigation","Mentoring","Regulatory communication","Training development"]

Serve as a subject-matter expert for Special Investigations Unit (SIU) investigations, guiding staff and managing a moderate-to-high complexity caseload. Evaluate allegations using federal/state regulations, CMS guidelines, and internal policies; conduct and review investigative interviews; document findings and produce clear reports. Identify training needs, assess risks, recommend remedial actions, analyze trends for fraud signals, and communicate with regulators. Testify in criminal and civil matters as needed.

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Centene
Centene
1 month ago

Lead SIU Investigator

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Source: Company careers pageValidated by: Fursa AI
Last checked: 23 days agoStatus: Live

Job Summary

Serve as a subject-matter expert for Special Investigations Unit (SIU) investigations, guiding staff and managing a moderate-to-high complexity caseload. Evaluate allegations using federal/state regulations, CMS guidelines, and internal policies; conduct and review investigative interviews; document findings and produce clear reports. Identify training needs, assess risks, recommend remedial actions, analyze trends for fraud signals, and communicate with regulators. Testify in criminal and civil matters as needed.
Location: Missouri, Idaho, Arizona, Washington, Colorado, Texas, Nevada, California
Workplace: Remote
Employment Type: Full time
Job Function: Administration & Executive Assistance
Seniority: Mid level

Key Responsibilities

  • •Provide guidance to SIU investigators remediating compliance and fraud, waste, and abuse matters.
  • •Assist the manager with monitoring team caseloads and reporting metrics.
  • •Evaluate allegations using federal/state regulations, CMS guidelines, and internal policies, and conduct and document interviews.
  • •Manage moderate-to-high complexity investigations, develop investigative plans, and thoroughly document and review case files.
  • •Identify training needs, provide training and mentoring, detect trends/aberrant activity, and recommend remedial actions; communicate with regulators and support referrals to agencies/law enforcement.

Pay and Benefits

Salary: USD 70,100 - 126,200 annually
Equity and Bonus:Equity
Perks:Health Insurance401kEquityPaid Leave

Key Requirements

  • •Bachelor's degree in a related field (or Associate's degree with 6 years related experience, or High School/GED with 7 years related experience)
  • •5+ years of healthcare fraud-related investigations with audit and risk analysis
  • •1+ years in managed care or working with a health insurance company
  • •In-depth knowledge of government programs and managed care, including Medicare, federal/state civil and criminal statutes
  • •Ability to read, analyze, and interpret state and federal laws, rules, and regulations
Experience:5+ yearsHealthcareHealthcare fraudManaged careMedicareHealth insurance
Education:Bachelor's
Skills:Risk assessmentInvestigationMentoringRegulatory communicationTraining development
Certifications:AHFICFE

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