Position acts as a subject matter expert in the field of Compliance and/or Special Investigations Unit (SIU) investigations
Job Summary
Position acts as a subject matter expert in the field of Compliance and/or Special Investigations Unit (SIU) investigations.
Provides direction and guidance to staff who investigate and remediate compliance and fraud, waste, and abuse related matters; while maintaining an investigative workload of moderate to high complexity.
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.
Matching Summary
Position acts as a subject matter expert in the field of Compliance and/or Special Investigations Unit (SIU) investigations.
Salary
$70,100.00 - $126,200.00 per year
Skills & Requirements
Must-have
subject matter expert in SIU investigations
guidance to staff on investigations
manage caseloads of moderate to high complexity
identify trends and aberrant activity
communicate directly with regulators
prepare cases for referral
Nice-to-have
fresh perspective on workplace flexibility
strong working relationships with associates and regulators
support development of policies and procedures
Key Requirements
Bachelor's Degree in related field; or Associate's degree with 6 years related experience; or High School Diploma/GED with 7 years related experience
5+ years Healthcare fraud-related investigations
1+ years Managed care or working with health insurance company
In-depth knowledge of government programs, managed care, Medicare, Medicaid laws
Reading, analyzing and interpreting State and Federal laws, rules and regulations