Fraud & Payment Integrity Program Lead (Remote/Hybrid)

Centene Corporation

Missouri

Hybrid

USD 88,000 - 158,000

Full time

14 days+

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Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work schedules (remote,hybrid

Office or field work

Job summary

Centene Corporation is hiring for a strategic role to develop, implement, and manage fraud, waste and abuse activities across health plans. You will lead teams to investigate referrals, ensure compliance with billing and claims processes, and tailor plans to meet federal requirements.

Applicants should have a bachelor’s degree in a related field and 4+ years in medical claim investigation or compliance, preferably within managed care, with strong knowledge of medical terminology and leadership

Qualifications

4+ years of medical claim investigation, compliance or fraud and abuse experience.
Thorough knowledge of medical terminology.
Experience in a managed care environment and as a lead or supervisor of staff.

Responsibilities

Monitor billing and claims processes to ensure integrity and compliance.
Lead analysts to investigate fraud, waste and abuse referrals.
Develop customized fraud plans meeting contract and federal requirements.
Create educational materials to identify waste activities as needed.
Respond to RFPs and implement new policies per contractual obligation.
Attend state/federal meetings as required by contracts.
Present the FWA program to state/federal personnel during readiness reviews or go-live.