Remote Fraud & Payment Integrity Manager

Centene Corporation; Florida; Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Flexible work schedules

Job summary

Centene Corporation is seeking a senior professional to develop, implement, and manage strategic fraud, waste and abuse activities while ensuring compliance with state and federal requirements. You will lead analysts, monitor billing and claims, and prepare savings reports.

A Bachelor's degree plus 4+ years of related experience are required, with preferred managed care leadership and coding licensure. The role offers flexible scheduling, including remote, hybrid, field, or office work

Qualifications

• 4+ years of medical claim investigation, compliance or fraud and abuse experience.
• Thorough knowledge of medical terminology.
• Managed care experience; lead/supervisor experience preferred.
• Medical records or coding license preferred.

Responsibilities

• Monitor billing and claims processes to ensure integrity and compliance.
• Lead teams of analysts to investigate fraud, waste and abuse referrals.
• Develop customized FWA plans to meet contract and federal requirements.
• Prepare monthly and quarterly saving reports.

Skills

Fraud investigation

Compliance

Leadership

Medical terminology

Education

Bachelor's degree in Business, Healthcare, Criminal Justice or related field

Job description

Centene Corporation is seeking a senior professional to develop, implement, and manage strategic fraud, waste and abuse activities while ensuring compliance with state and federal requirements. You will lead analysts, monitor billing and claims, and prepare savings reports.

A Bachelor's degree plus 4+ years of related experience are required, with preferred managed care leadership and coding licensure. The role offers flexible scheduling, including remote, hybrid, field, or office work