Senior Fraud & Payment Integrity Lead (Remote)

Centene Corp.; Missouri; Hybrid; USD 88,000 - 158,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Flexible work arrangements: remote,hyb

Job summary

Centene Corp. is seeking a senior professional to develop, implement, and manage strategic fraud, waste and abuse activities within a managed care environment in Missouri.

You will lead analysts, monitor billing integrity, and respond to contracts and regulatory requirements across state and federal levels. The role emphasizes leadership, educational material creation, and comprehensive reporting, with responsibilities spanning RFP responses, policy implementation, and program readiness reviews.

Qualifications

• Bachelor’s degree in Business, Healthcare, Criminal Justice, related field, or equivalent experience.
• 4+ years of medical claim investigation, compliance or fraud and abuse experience.
• Thorough knowledge of medical terminology required.
• Previous experience in managed care environment and as a lead or supervisor of staff, including hiring, training, assigning work and managing performance preferred.

Responsibilities

• Monitor business processes and systems to assure integrity and compliance in billing and claims payment.
• Lead teams of analysts to appropriately investigate all possible fraud, waste and abuse referrals.
• Develop customized fraud plans to meet contract and federal requirements.
• Develop educational materials to identify/validate waste activities as requested by the health plan and on an ad-hoc basis.
• Respond to RFP requests and implement new policies per contractual obligation.
• Attend state/federal meetings as required by specific contracts.
• Prepare/present the FWA program to state/federal personnel during readiness reviews and post-go-live changes.
• Review post-payment cases with appropriate parties to obtain refund.
• Prepare and distribute monthly and quarterly saving reports.
• Performs other duties as assigned.
• Complies with all policies and standards.

Skills

Medical claim investigation

Compliance

Fraud and abuse investigation

Leadership / supervision

Education

Bachelors degree in Business, Healthcare, Criminal Justice, related field

Job description

Centene Corp. is seeking a senior professional to develop, implement, and manage strategic fraud, waste and abuse activities within a managed care environment in Missouri.

You will lead analysts, monitor billing integrity, and respond to contracts and regulatory requirements across state and federal levels. The role emphasizes leadership, educational material creation, and comprehensive reporting, with responsibilities spanning RFP responses, policy implementation, and program readiness reviews.