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: Manage compliance with all Federal and State Laws and Regulations related to program integrity and disclosure requirements. Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends and schemes.
- Dedicated to our Indiana Medicaid product lines.
- Safeguard against the potential for fraud, waste and abuse and coordinate with, the Special Investigations Unit and state agencies to promptly investigate reports of, suspected fraud and abuse by employees, subcontractors, providers, and others with whom the health plan does business
- Serve as the health plan’s primary fraud, waste and abuse subject matter expert
- Coordinate audit documentation, develop internal and state required reports and internal policies and procedures
- Arrange, conduct and attend the health plan’s fraud, waste and abuse work groups and participate in other various committees
- Act as the primary liaison with the State to ensure assure coordination efforts with state agencies concerning program integrity issues
Knowledge/Experience: Bachelor’s degree in Business, Healthcare, Criminal Justice, related field, or equivalent experience. 4+ years of combined medical claim investigation, financial impact analysis, business analysis, compliance or fraud and abuse experience. Thorough knowledge of medical terminology. Previous experience in managed care environment and as a lead or supervisor of staff, including hiring, training, assigning work and managing performance preferred. Knowledge of Microsoft Excel, medical coding, claims processing, and data mining preferred.
Please note: candidate must reside within the state of Indiana.
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
