Compliance Oversight Specialist (Non Clinical)

Centene Corp.; Northern (KY); Hybrid; USD 56,000 - 101,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible remote/hybrid/field or office

Job summary

Centene Corp. in the United States seeks a Senior Compliance Analyst to oversee ethics and regulatory compliance for WellCare and delegated subcontractors, focusing on audits and remediation to meet government program requirements.

You will collaborate with business owners and vendors, assess contracts, review corrective actions, and report findings to senior leadership. A CHC is preferred; a Bachelor's degree or equivalent and 3+ years in managed care are required.

Qualifications

• Bachelor's degree required or 4 years of applicable experience with an associate.
• 3+ years of experience in Managed Care/Health Insurance.
• CHC certification preferred.

Responsibilities

• Oversee WellCare and delegated subcontractor ethics and compliance programs.
• Conduct focused reviews, audits, and oversight to meet government program requirements.
• Collaborate with business owners and vendors to drive remediation and oversee corrective actions.
• Prepare formal written reports on findings and ensure supporting workpapers.

Skills

Managed Care

Regulatory Compliance

Audit Oversight

Stakeholder Communication

Education

Bachelor's degree or equivalent

Associates with 4 years experience

GED/HS diploma with 5 years experience

Job description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. *Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States*

Position Purpose:

Participates in the oversight of WellCare's and/or its delegated subcontractor's corporate ethics and compliance program, and ongoing oversight and analysis of regulatory compliance issues. Responsibilities includes conducting focused reviews and audit, oversight, and monitoring of activities to assess compliance with WellCare's contractual and regulatory requirements; collaborates with business owners and/or delegated vendors to drive remediation and assist WellCare and delegated subcontractors to maintain integrity through oversight and monitoring and in meeting Government-sponsored health care program requirements; collaborates with and assist those within the Company and the Company’s delegated subcontractors to maintain integrity through oversight and monitoring and in meeting the requirements of our executed contracts with Government-sponsored health care programs; Assists in the assessment of new and amended Government-sponsored health care program contracts and requirements; Assists Markets (local), Shared Services (corporate), and/or delegated subcontracts in the identification and assessment of compliance risks; Evaluates the effectiveness of Market (local), Shared Services (corporate), and/or delegated subcontractor compliance programs and related policies and procedures designed to promote legal and ethical compliance; Prepares accurate and timely formal written reports on oversight and monitoring activity findings and recommendations and ensure workpapers are properly prepared in accordance with WellCare and departmental standards, including sufficient evidentiary material exists to support oversight and monitoring activity findings; Collaborates with other departments and/or delegated subcontractors to direct compliance issues to appropriate channels for research and resolution; Reviews and evaluates the status and effectiveness of corrective action plans and provide comprehensive follow up to stakeholders, Senior Management, Market Compliance Oversight Committees, and/or the Audit, Finance, and Regulatory Compliance Committee of the Board of Directors; Participates in special projects as needed, including training; Performs other duties as assigned; Complies with all policies and standards.

Education/Experience:

• A Bachelor's Degree in Related field, or Associates with 4 years of applicable experience, or HSD/GED with 5 years of applicable experience in lieu of Bachelor’s degree required
• Required 3+ years of experience in Managed Care/Health Insurance
• Preferred 1+ year of experience in project oversight type role with demonstrated ability to drive implementation and influence others
• Preferred 1+ year of experience in reading, analyzing, and interpreting State and Federal laws, rules and regulations
• Preferred 1+ year of experience in State Medicaid or Federal managed care compliance

Licenses and Certifications:

Certified in HealthCare Compliance (CHC) preferred

Pay Range:

Pay Range: $56,200.00 - $101,000.00 per year

Benefits:

Centene offers a comprehensive benefits package including:

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Centene is committed to helping people live healthier lives. We provide access to high-quality healthcare, innovative programs and a wide range of health solutions that help families and individuals get well, stay well and be well.