Ensures the integrity, quality, and compliance of healthcare investigations through audits, process improvements, and collaboration with investigative teams
Job Summary
Ensures the integrity, quality, and compliance of healthcare investigations through audits, process improvements, and collaboration with investigative teams.
Combines analytical review, training, reporting, and some policy development to support organizational goals and regulatory standards.
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.
Matching Summary
Ensures the integrity, quality, and compliance of healthcare investigations through audits, process improvements, and collaboration with investigative teams.
Salary
Base: $56,200.00 - $101,000.00 per year; Bonus/Equity: Not specified; Benefits: Comprehensive benefits package
Skills & Requirements
Must-have
healthcare investigations
audit case documentation
process improvements
risk identification
policy development
Nice-to-have
analytical review
collaboration with teams
training support
organizational goals alignment
Key Requirements
Bachelor's Degree Business, Criminal Justice, Healthcare, related field or equivalent experience
3+ years experience in medical claim investigation, medical claim audit, medical claim analysis, SIU functions or healthcare fraud investigation
2+ years with a relevant certification (CFE, AHFI, CIA, CHC, CPC or CPMA)