Payment Integrity Specialist

Centene Corporation; Missouri; Hybrid; USD 70,000 - 126,000; Full time

Job summary

Centene Corporation is seeking a Business Process Consultant to lead large-scale cross-functional initiatives that improve performance, compliance, and customer outcomes. You will support business case development, align policy and technology, and drive end-to-end process integrity across the organization.

The role requires a Bachelor's degree (Master's preferred) and 5+ years in health care or related fields, with demonstrated skills in training, facilitation, and data analysis.

Qualifications

• Bachelor's Degree in a related field or equivalent experience required
• Master’s Degree in a related field preferred
• 5+ years health care, insurance or related experience required
• Demonstrated experience and skill in training, presenting and facilitating required

Responsibilities

• Lead large scale, cross-functional initiatives that drive performance improvement and compliance.
• Assists business case development to assess opportunities, risks and ROI.
• Organize work teams, establish project plans, and drive consensus.
• Perform detailed analysis of data, workflows, and policies to propose solutions.
• Provide policy guidance to ensure end-to-end process integrity and successful implementation.

Skills

Project management

Data analysis

Facilitation

Communication

Education

Bachelor's degree in related field

Master's degree in related field

Tools

Excel

PowerPoint

Visio

Microsoft Project

Job description

Position Purpose:

The Business Process Consultant leads large scale, cross-functional initiatives.

• Assists business case development for those proposed initiatives to which are assigned to ensure adequate assessment of opportunities, risks and return on investment.
• Facilitates the optimization of business unit performance by enhancing alignment of policy, process and technology and designing/implementing for future business needs as well.
• Leads large scale, cross-functional initiatives that are intended to drive performance improvement, financial gains, customer satisfaction and improved compliance.
• Provides policy guidance on assigned initiatives so that end-to-end processes are considered for maximizing effective implementation.
• Organizes work teams, drives consensus and ensures end-to-end policy/process integrity to accomplish project work including: identification and confirmation of participants, establishment of a project plan, consistent work team engagement and productivity, meeting facilitation, consensus building, recommendation documentation and implementation oversight.
• Performs detailed analysis of data, workflows, policies, procedures, organization of staff, skills and offer potential solutions in order to execute initiatives.
• Supports the project work by utilizing project management software such as, but not limited to, Excel, PowerPoint, Visio, and Microsoft Project.
• Leads all levels of staff who are responsible for initiatives included in the company’s operating plan in order to support their success, development and effective completion and communication of their initiatives.
• Assists other project leaders in specific areas as needed such as facilitation, analysis, process mapping, brain-storming, project management issues, etc.
• Writes and delivers communication to all levels of organization to ensure support, awareness and effectiveness of process improvement initiatives.
• Possesses and utilizes knowledge and experience leveraging IT solutions.
• Provides other related support as needed to improve the performance of the business.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

Bachelor's Degree in a related field or equivalent experience required
Master’s Degree in a related field preferred
5+ years health care, insurance or related experience required
Demonstrated experience and skill in training, presenting and facilitating required

Pay Range: $70,100.00 - $126,200.00 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