Manager, Special Investigation Unit (SIU)

Centene
Arizona, Nevada
Workplace: RemoteFull timeUSD 87,700 - 157,800 annuallyFunction: Legal, Risk & ComplianceExperience: 4+ yearsEducation: bachelorsSkills: ["Leadership","Analysis","Investigation","Compliance"]

Develop and manage strategic fraud, waste, and abuse activities by maintaining state and federal requirements and monitoring trends and schemes. Lead investigations into referrals, ensure integrity and compliance in billing and claims payment, and review post-payment cases to obtain refunds. Create educational materials, attend required state/federal meetings, and produce monthly and quarterly savings reports while participating in appeals and cross-functional workgroups.

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FursaFursa
Centene
Centene
1 month ago

Manager, Special Investigation Unit (SIU)

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

Source: Company careers pageValidated by: Fursa AI
Last checked: 26 days agoStatus: Live
Reposted: similar role first listed 4 months ago

Job Summary

Develop and manage strategic fraud, waste, and abuse activities by maintaining state and federal requirements and monitoring trends and schemes. Lead investigations into referrals, ensure integrity and compliance in billing and claims payment, and review post-payment cases to obtain refunds. Create educational materials, attend required state/federal meetings, and produce monthly and quarterly savings reports while participating in appeals and cross-functional workgroups.
Location: Arizona, Nevada
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 investigations into fraud, waste, and abuse referrals and manage team performance.
  • •Review post-payment cases with appropriate parties to obtain refunds.
  • •Prepare and distribute monthly and quarterly savings reports and participate in appeals, work groups, and interdepartmental meetings.

Pay and Benefits

Salary: USD 87,700 - 157,800 annually
Perks:Health Insurance401kEquityPaid Leave

Key Requirements

  • •Bachelor’s degree in Business, Healthcare, Criminal Justice, related field, or equivalent experience.
  • •4+ years of combined medical claim investigation, financial impact analysis, business analysis, compliance, or fraud and abuse experience.
  • •Thorough knowledge of medical terminology.
  • •Experience working with Dental and Vision plans.
  • •Knowledge of Microsoft Excel, medical coding, claims processing, and data mining preferred.
Experience:4+ yearsMedical claimsManaged care
Education:Bachelor's in Business, Healthcare, Criminal Justice, related field
Skills:LeadershipAnalysisInvestigationCompliance
Certifications:Medical coding license
Tech Stack:Microsoft ExcelMedical codingClaims processingData mining

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