Fraud & Payment Integrity Manager (Remote/Hybrid)

Centene Corporation; Texas; Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work schedules (remote/hybrid

Job summary

Centene Corporation in the United States is seeking a Fraud, Waste and Abuse Leader to develop, implement and manage strategic FWA activities by maintaining state and federal requirements and monitoring trends.

You will monitor billing and claims systems for integrity, lead analysts in investigations, and develop plans to meet contractual obligations. This role offers flexible work options including remote or hybrid, with collaboration across health plans and state/federal stakeholders.

Qualifications

• Bachelor's degree in Business, Healthcare, Criminal Justice, or related field.
• 4+ years of medical claim investigation, compliance or fraud and abuse experience.
• Experience in managed care and as a lead or supervisor of staff.

Responsibilities

• Monitor billing and claims payment processes to ensure integrity and compliance.
• Lead teams of analysts to investigate fraud, waste and abuse referrals.
• Develop customized fraud plans to meet contract and federal requirements.
• Prepare monthly and quarterly saving reports and present findings.

Skills

Fraud investigation

Leadership

Compliance

Healthcare operations

Education

Bachelor's degree in Business, Healthcare, Criminal Justice, related field

Job description

Centene Corporation in the United States is seeking a Fraud, Waste and Abuse Leader to develop, implement and manage strategic FWA activities by maintaining state and federal requirements and monitoring trends.

You will monitor billing and claims systems for integrity, lead analysts in investigations, and develop plans to meet contractual obligations. This role offers flexible work options including remote or hybrid, with collaboration across health plans and state/federal stakeholders.