Manager, Payment Integrity-COB/TTL Vended Programs

Centene
Missouri, Georgia, North Carolina, Texas, Illinois, Florida
Workplace: RemoteFull timeUSD 87,700 - 157,800 annuallyFunction: Communications, PR & CommunityExperience: 4+ yearsEducation: bachelorsSkills: ["Investigating","Compliance management","Program management","Stakeholder communication","Reporting"]

Lead strategic fraud, waste, and abuse (FWA) activities by developing and managing programs that meet state and federal requirements. Monitor billing and claims payment processes for integrity and compliance, investigate fraud referrals, and create customized fraud plans aligned to contractual obligations. Present the FWA program during readiness reviews and after go-live or state changes, handle post-payment case reviews for refunds, and produce monthly and quarterly savings reporting.

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Centene
Centene
3 days ago

Manager, Payment Integrity-COB/TTL Vended Programs

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Source: Company careers pageValidated by: Fursa AI
Last checked: 4 hours agoStatus: Live

Job Summary

Lead strategic fraud, waste, and abuse (FWA) activities by developing and managing programs that meet state and federal requirements. Monitor billing and claims payment processes for integrity and compliance, investigate fraud referrals, and create customized fraud plans aligned to contractual obligations. Present the FWA program during readiness reviews and after go-live or state changes, handle post-payment case reviews for refunds, and produce monthly and quarterly savings reporting.
Location: Missouri, Georgia, North Carolina, Texas, Illinois, Florida
Workplace: Remote
Employment Type: Full time
Job Function: Communications, PR & Community
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 to meet contract and federal requirements and respond to RFPs with new policies.
  • •Prepare and present the FWA program for state/federal personnel, review post-payment cases for refunds, and deliver monthly and quarterly savings reports.

Pay and Benefits

Salary: USD 87,700 - 157,800 annually
Perks:Health Insurance401kEquityRemote 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.
  • •Previous experience in managed care and as a lead or supervisor (hiring, training, assigning work, managing performance).
  • •Medical records or coding license preferred.
Experience:4+ yearsHealthcareMedical claimsManaged care
Education:Bachelor's in Business, Healthcare, Criminal Justice, related field
Skills:InvestigatingCompliance managementProgram managementStakeholder communicationReporting
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