Payment Integrity Systems Specialist II

Centene Management Company LLC; Missouri; Hybrid; USD 64,000 - 115,000; Full time

Benefits offered by this job

Competitive compensation

Health insurance

Job summary

Centene is seeking a Payment Integrity Systems Specialist II to perform moderately complex analysis of platform outputs, financial and operational data, and workflow performance. You will develop dashboards, validate data, and support release readiness while coordinating with cross‑functional teams across Operations, Technology, and Finance.

The role requires 2+ years in Payment Integrity or related analytics, with proficiency in Excel, SQL, and Power BI, and a Bachelor's degree in a related

Qualifications

• Bachelor's degree in healthcare, business, finance, accounting, information systems, data analytics, or related field; 2+ years in Payment Integrity or related analytics.
• Experience with Excel, SQL, Power BI, and financial reporting tools.
• Proficient in UAT, testing documentation, dashboards, and cross‑functional issue resolution.
• Knowledge of managed care claims, Payment Integrity concepts, and operational controls.

Responsibilities

• Analyze moderately complex Payment Integrity platform outputs, claims data, and workflow performance.
• Develop and maintain dashboards, trackers, and recurring reports for visibility and savings opportunities.
• Coordinate UAT, regression testing, validation, and release readiness for system changes.
• Manage defects, enhancement requests, and intake items; document requirements and track status.
• Collaborate with Operations, Technology, Finance, governance, and business stakeholders.

Skills

Data analysis

Stakeholder communication

UAT/testing

Cross-functional collaboration

Process improvement

Education

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

Tools

ServiceNow

Power BI

SQL

Excel

Job description

Position Purpose

Position Purpose: The Payment Integrity Systems Specialist II performs moderately complex Payment Integrity systems, data, reporting, and workflow analysis. The role supports platform enhancements, defect remediation, reporting routines, UAT/release readiness, financial and operational data validation, and cross-functional follow-up across Operations, Technology, Finance, and governance stakeholders. Conduct moderately complex analysis of Payment Integrity platform outputs, claims system data, edit/rule behavior, financial/reporting outputs, and workflow performance to identify exceptions, trends, and operational impacts. Manage moderately complex ServiceNow or similar incidents, defects, enhancement requests, and intake items by documenting requirements, tracking status, coordinating follow-up, and escalating blockers. Coordinate UAT, regression testing, validation, and release‑readiness activities for system changes, including defect validation and communication of operational impacts. Develop and maintain dashboards, trackers, recurring reports, and workstream visibility tools for platform enhancements, defects, metrics, savings opportunities, and operational improvement initiatives. Gather and analyze data using Excel, SQL, Power BI, financial reporting tools, or approved reporting platforms to validate outputs and support decision‑making. Partner with Operations, Technology, Finance, governance/delivery, and business stakeholders to clarify requirements, document decisions, and support transformation workstreams. Apply consistent standards and methodologies to improve data quality, documentation, process consistency, and operational readiness. May provide informal guidance or onboarding support to less‑experienced team members. Performs other duties as assigned. Complies with all policies and standards.

Education/Experience

Education/Experience: Bachelor's degree in healthcare, business, finance, accounting, information systems, data analytics, or a related field, or equivalent experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. 2+ years of relevant experience in Payment Integrity systems, managed care claims systems, data analytics, financial reporting, business analysis, platform support, quality assurance, UAT, or related technical healthcare function. required. Working knowledge of managed care claims, Payment Integrity concepts, system workflows, reporting, and operational controls. required. Experience with ticketing, UAT/testing documentation, dashboards, workflow tracking, data validation, and cross‑functional issue resolution. required. Working proficiency with Excel and developing proficiency with SQL, Power BI, financial reporting tools, or similar data/reporting platforms. required. License/Certification: Credentials or training in Power BI, SQL, business analysis, Lean Six Sigma, healthcare data analytics, project coordination, or coding/claims concepts where relevant. preferred LPN, RN, CPC, CPC-H, CPC-P, CCS, CCS-P, RHIT, RHIA, or CPMA. RHIT, CCS, CIC, CCDS. preferred

• Platform Support & Governance required.
• Data Validation & Reporting required.
• Defect & Enhancement Intake required.
• UAT / Regression Testing required.
• Release Readiness required./li>
• Financial Systems / Reporting required.
• Dashboard / KPI Development required.
• Configuration & Edit Support required.
• Related Payment Integrity systems and technology support functions required.
• Experience with Payment Integrity platforms, claims systems, ServiceNow, Power BI, edit/rule configuration, workflow automation, or platform modernization workstreams. preferred.
• Working knowledge of financial systems, accounting principles, and operational financial reporting preferred. preferred.

Pay Range

Pay Range: $63,600.00 - $114,600.00 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.

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules

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.

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.