Manager, Payment Integrity - Platform Management

Centene

Base: $87,700.00 - $157,800.00 py; bonus/equity: n...
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Medical claim investigation experience
Thorough knowledge of medical terminology
State and federal compliance monitoring
** Centene is seeking a Manager for Payment Integrity in Platform Management to lead fraud, waste, and abuse initiatives, ensuring compliance with state and federal requirements. The ideal candidate will have experience in medical claim investigation and a strong understanding of healthcare compliance. **

Job Summary

  • The role involves developing and implementing strategic fraud, waste, and abuse activities to maintain state and federal requirements for 28 million members.
  • Candidates will lead teams of analysts to investigate fraud referrals and prepare monthly and quarterly saving reports.
  • Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K, and flexible work schedules.

Matching Summary

Match Score: 75

** Centene is seeking a Manager for Payment Integrity in Platform Management to lead fraud, waste, and abuse initiatives, ensuring compliance with state and federal requirements. The ideal candidate will have experience in medical claim investigation and a strong understanding of healthcare compliance. **

Salary

Base: $87,700.00 - $157,800.00 per year; Bonus/Equity: Not specified; Benefits: Health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off

Skills & Requirements

Must-have

  • Medical claim investigation experience
  • Thorough knowledge of medical terminology
  • State and federal compliance monitoring
  • Fraud waste and abuse program development

Nice-to-have

  • Managed care environment experience
  • Data mining and claims processing skills
  • Microsoft Excel proficiency
  • Staff hiring and performance management

Key Requirements

  • Bachelor's degree in Business, Healthcare, or Criminal Justice
  • 4+ years of medical claim investigation or compliance experience
  • Previous experience as a lead or supervisor preferred
  • Medical records or coding license preferred

Work Rights

Not specified

Tailored Resume

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