Lead SIU Analytics & Fraud Innovation (Remote)

Centene Corp.; New York (NY); On-site; USD 88,000 - 158,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off and holidays

Flexible work schedules

Job summary

Centene Corp. seeks a Manager, SIU Intelligence & Innovation to lead a team focused on detecting, preventing, and investigating fraud, waste, and abuse across healthcare programs. You will shape analytics strategies, utilize advanced tools, and collaborate with enterprise stakeholders to drive proactive investigations and value realization.

You will mentor staff, manage data assets, and oversee vendor partnerships while aligning initiatives with regulatory requirements and emerging fraud trends.

Qualifications

• Bachelor's Degree in Data Analytics, Data Science, Business Analytics, Business or Healthcare Administration, Information Systems, Statistics, Computer Science, Criminal Justice, or related field; or equivalent experience required.
• Master's Degree preferred.
• Juris Doctor (JD) preferred.
• 5+ years Healthcare analytics, fraud detection, SIU operations, program integrity, payment integrity, healthcare investigations, or related analytical functions required.
• 2+ years Conducting healthcare fraud investigations and knowledge of fraud, waste, and abuse trends and schemes required.
• Experience leading, mentoring, coordinating, or managing analytical resources, projects, or teams required.
• Experience developing and implementing advanced analytics, predictive monitoring, reporting, data visualization, and fraud detection methodologies using large and complex healthcare datasets to generate actionable business insights and support operational decision-making required.
• Experience collaborating with cross-functional stakeholders across operational, compliance, investigative, and analytics functions to drive data-informed strategies related to healthcare fraud, waste, and abuse prevention, managed care operations, and organizational performance improvement required.
• Experience leading healthcare analytics, SIU, Program Integrity, Payment Integrity, Compliance, or fraud, waste and abuse (FWA) initiatives, including development of analytics strategies, roadmaps, performance metrics, value realization methodologies, and operational improvement efforts preferred.
• Experience applying advanced analytics, predictive modeling, artificial intelligence, machine learning, fraud detection technologies, and external data resources to support proactive fraud identification, complex investigations, vendor and partnership oversight, and compliance with healthcare regulatory and industry requirements preferred.

Responsibilities

• Leads the strategic direction, development, and optimization of SIU capabilities to detect, prevent, and investigate FWA.
• Manages analytics personnel, enterprise data initiatives, and vendor relationships to drive value realization.
• Develops proactive analytics, dashboards, reporting, and predictive monitoring with stakeholders across the organization.
• Transforms large datasets into actionable intelligence to support investigations and program integrity.
• Represents SIU in governance, analytics, innovation, and strategic planning forums.
• Mentors and develops staff, oversees performance, and aligns resources with objectives.
• Keeps abreast of external trends, regulatory developments, and industry partnerships.

Skills

Data Analytics

Healthcare analytics

Fraud detection

Leadership

Mentoring

Cross-functional collaboration

Predictive modeling

AI/ML

Data visualization

Regulatory compliance

Education

Bachelor's degree

Master's degree preferred

Juris Doctor preferred

Certifications (CFE, AHFI, CHC, PMP, SAS, CPC) preferred

Tools

SAS

Job description

Centene Corp. seeks a Manager, SIU Intelligence & Innovation to lead a team focused on detecting, preventing, and investigating fraud, waste, and abuse across healthcare programs. You will shape analytics strategies, utilize advanced tools, and collaborate with enterprise stakeholders to drive proactive investigations and value realization.

You will mentor staff, manage data assets, and oversee vendor partnerships while aligning initiatives with regulatory requirements and emerging fraud trends.