Lead Payment Integrity Systems Specialist

Centene Corporation; Illinois; Hybrid; USD 87,000 - 161,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements

Job summary

Centene Corporation seeks a Lead Payment Integrity Systems Specialist to serve as the enterprise SME for analytics, governance, and reporting across Payment Integrity systems. You will define standards, drive cross-functional initiatives, and communicate strategic insights to senior leaders.

The role demands expertise in data storytelling, dashboards, and financial reporting, with a focus on improving operational visibility and platform governance.

Qualifications

• Bachelor's degree or equivalent experience in a related field.
• 5+ years of relevant experience in Payment Integrity systems, managed care claims, or related healthcare analytics.
• Advanced proficiency with SQL, Power BI, Excel, and executive-level data storytelling.

Responsibilities

• Lead enterprise-level analysis of Payment Integrity data to identify risks and opportunities.
• Set standards for data validation, dashboarding, and reporting routines.
• Coordinate cross-functional governance with Operations, Technology, and Finance.
• Own incident, defect, and release governance across Payment Integrity systems.
• Translate complex data into executive-ready summaries and recommendations.
• Provide technical leadership and mentorship to PI Systems teams.

Skills

Executive communication

Data storytelling

SQL

Power BI

Advanced analytics

Leadership without authority

Data validation

Dashboard development

Cross-functional collaboration

Operational governance

Education

Bachelor's degree in healthcare, business, finance, accounting, information systems, data analytics, or related field

Tools

SQL

Power BI

Excel

ServiceNow

Job description

Position Purpose

The Lead Payment Integrity Systems Specialist is the senior individual contributor and enterprise-level subject-matter expert for Payment Integrity systems, platform governance, analytics, financial reporting, and operational visibility. The role sets technical and operating standards, leads complex cross-platform analysis, advises leadership, shapes prioritization decisions, and drives solutions across Operations, Technology, Finance, and governance stakeholders.

• Lead enterprise-level analysis of complex Payment Integrity system, claims, workflow, financial, and reporting data to identify strategic risks, prioritization decisions, savings opportunities, and operational improvement recommendations.
• Set standards for technical review, data validation, dashboarding, reporting routines, ServiceNow intake, defect/enhancement prioritization, UAT/release readiness, post-release issue tracking, and operational visibility.
• Serve as the senior business-technology liaison for platform change management, aligning Operations, Technology, Finance, governance, and leadership stakeholders on scope, impact, risk, decisions, and readiness.
• Own operating routines that prioritize and govern incidents, defects, enhancements, releases, automation opportunities, and modernization workstreams across Payment Integrity systems.
• Translate complex cross-platform results into executive-ready summaries, strategic recommendations, implementation plans, and measurable success criteria.
• Advise leadership on platform governance, financial reporting considerations, data quality controls, process standardization, and long-term system capability needs.
• Lead the design and continuous improvement of methodologies, standards, and job-family consistency across Payment Integrity system support and analytics functions.
• Provide technical leadership, coaching, peer review, and escalation support to PI Systems Specialist I, II, and Senior PI Systems Specialist team members.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education / Experience

• Bachelor's Degree in healthcare, business, finance, accounting, information systems, data analytics, or a related field, or equivalent experience required.
• 5+ years years of relevant experience in Payment Integrity systems, managed care claims systems, platform governance, financial reporting, healthcare analytics, business analysis, UAT/release readiness, or related technical healthcare function. required.
• Specialized depth and/or breadth of expertise in Payment Integrity systems, claims data, operational workflows, data governance, financial reporting, system dependencies, and cross-functional transformation. required.
• Advanced proficiency with SQL, reporting/analytics tools such as Power BI, financial reporting tools, Excel, ServiceNow or similar ticketing/workflow platforms, and executive-level data storytelling. required.
• Demonstrated ability to lead technical direction, resolve precedent-setting issues, influence without formal authority, and communicate with senior leaders. required.
• Platform Support & Governance required.
• Data Validation & Reporting required.
• UAT / Regression Testing required.
• Defect & Enhancement Intake required.
• Release Readiness required.
• Financial Systems / Reporting required.
• Dashboard / KPI Development required.
• Configuration & Edit Support required.
• Related Payment Integrity systems and technology support functions required.
• Advanced knowledge of financial systems and accounting principles preferred. preferred.
• Experience setting platform governance, operational visibility standards, dashboard/reporting strategy, release-readiness routines, and cross-functional technology operating models. preferred.

License / Certification

• Advanced credentials in data analytics, business analysis, healthcare data, project/program management, Lean Six Sigma, finance/accounting, SQL, or related systems disciplines. preferred
• License/Certification: LPN, RN, CPC, CPC-H, CPC-P, CCS, CCS-P, RHIT, RHIA, or CPMA. RHIT, CCS, CIC, CCDS. preferred

Pay Range: $87,000.00 - $161,300.00 per year

At Centene

We connect people to the care they need to live healthier lives - and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and 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