Remote Payment Integrity Policy Analyst II

Centene Corporation; Town of Florida (NY); Hybrid; USD 64,000 - 115,000; Full time

Benefits offered by this job

Health insurance

401K and stock purchase plan

Tuition reimbursement

Paid time off and holidays

Flexible work arrangements

Job summary

Centene Corporation is seeking a Payment Integrity Policy Specialist II to evaluate policy changes and ensure accurate claims adjudication. You will interpret federal/state updates, collaborate with Medical Affairs and Claims, and produce clear guidance for implementation and testing teams.

The role requires cross-functional communication, strong analytical abilities, and a track record in health insurance policy interpretation and regulatory review. Hybrid work options are available.

Qualifications

• Bachelor's degree and 2-4 years related experience in health insurance or policy.
• Strong analytical, writing, and stakeholder collaboration skills.
• Working knowledge of claims processing, reimbursement logic and policy interpretation.
• Proficiency with MS Office and familiarity with policy repositories.

Responsibilities

• Analyze new and updated Payment Integrity policies and regulatory changes.
• Interpret contractual provisions to support policy logic within claims workflows.
• Collaborate with Claims, Configuration Operations and vendors to validate rule interpretation.
• Develop policy summaries, implementation notes, and operational guidance for teams.

Skills

Policy interpretation

Regulatory knowledge

Analytical thinking

Documentation

Stakeholder collaboration

Education

Bachelor's degree

Tools

Microsoft Office

Policy repositories

Data visualization tools

Job description

Centene Corporation is seeking a Payment Integrity Policy Specialist II to evaluate policy changes and ensure accurate claims adjudication. You will interpret federal/state updates, collaborate with Medical Affairs and Claims, and produce clear guidance for implementation and testing teams.

The role requires cross-functional communication, strong analytical abilities, and a track record in health insurance policy interpretation and regulatory review. Hybrid work options are available.