Lead Payment Integrity Systems Specialist

Centene Management Company LLC; Missouri; Hybrid; USD 87,000 - 161,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Remote/hybrid/field or office options

Job summary

Centene Management Company LLC in Missouri seeks a Lead Payment Integrity Systems Specialist, a senior contributor and enterprise SME for payment integrity systems, governance, analytics and reporting. You will set standards, lead cross-platform analysis, advise leadership, and drive improvements across Operations, Technology and Finance, with a focus on data storytelling and executive summaries.

The role requires advanced SQL, Power BI, and experience with release readiness and metrics.

Qualifications

• Bachelor's degree or equivalent in a related field.
• 5+ years in Payment Integrity systems, analytics, or related healthcare tech.
• Advanced SQL and Power BI, data governance, and reporting experience.

Responsibilities

• Lead enterprise-level analysis of Payment Integrity data to identify risks and savings opportunities.
• Set standards for data validation, dashboards, and release readiness.
• Advise leadership on governance, reporting, and data quality.
• Coach PI Systems team members and oversee cross-functional projects.

Skills

SQL

Power BI

Data storytelling

Leadership

Analytics

Education

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

Tools

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
• 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.

Thanks for your interest in Centene and its subsidiary companies. We’re so glad that you’ve decided to fill out an application and take the next step to find your purpose. Also, we’re here to help support you on your candidate journey. Should you need an accommodation, please email [e-mail]. 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.