Payment Integrity Specialist - Governance

Centene Corporation; United States; Hybrid; USD 108,000 - 199,000; Full time

Job summary

Centene Corporation is seeking an experienced Business Analyst to lead enterprise system implementations and guide clients through complex healthcare workflows. The role focuses on requirements analysis, process improvements, and testing across functional and technical teams to ensure alignment with product capabilities.

The ideal candidate has 8+ years in health care or related industries, a computer science/ MIS background, and the ability to train users and collaborate with sponsors to define

Qualifications

• Experience as a business analyst or consultant in health care, insurance, or regulated industries.
• Experience leading enterprise system implementations.
• Ability to elicit and document workflow and business requirements.

Responsibilities

• Drive assessment of customer requirements against baseline system offerings.
• Recommend business process improvements to minimize changes.
• Demonstrate system to customer SMEs to align workflows.
• Develop and maintain test plans and document results.
• Create training collateral to train super users.
• Define scope and requirements with sponsors and program management.
• Gather workflow requirements by guiding clients through processes.
• Elicit requirements via interviews, workshops, surveys, and use cases.
• Design workflows using Casenet GUI tools.
• Lead client through functional, integration, and user acceptance testing.
• Collaborate with PM and resource managers to maximize Casenet opportunities.

Skills

Requirements gathering

Business analysis

Process improvement

UAT coordination

Training collateral

Stakeholder management

Education

Bachelor’s degree in Computer Science, MIS or related field

Master’s degree preferred

Tools

Casenet GUI

Job description

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Lead project team and potentially support analysts on functional enterprise system implementations and analyzing client operations and health care delivery models to determine opportunities to streamline processes and automate where appropriate while minimizing application changes. Act as an advisor to the team throughout the entire product development process.

• Drive assessment of customer requirements against baseline system offerings to identify and document fits versus gaps
• Work with implementation team to recommend business process improvements that minimize potential application changes
• Perform system demonstrations to customer subject matter experts in support of workflow and product alignment review efforts
• Develop and maintain test plans, conduct system testing, and document results for system process improvements
• Participate in creating training collateral to train super users on product interface
• Collaborate with business sponsors and Casenet program management to define and manage the scope, requirements analysis and implementation of projects
• Gather and document workflow and business requirements by guiding clients through their workflow processes in alignment with product capability
• Elicit requirements using interviews, document analysis, requirements workshops, surveys, site visits, business process descriptions, use cases, scenarios, business analysis, task and workflow analysis
• Use Casenet GUI software tools to design workflows, screens, fields based on gathered business requirements
• Lead client through functional, integration, and user acceptance testing processes
• Collaborate with project manager and resource managers to identify areas to maximize Casenet opportunity

Education/Experience: Bachelor’s degree in Computer Science, MIS or related field or equivalent. Masters degree preferred. 8+ years of experience as a business analyst or consultant in health care, insurance, or regulated industry preferred.

Pay Range: $107,700.00 - $199,300.00 per year

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