Lead Payment Integrity Systems Specialist

Centene Corporation•Remote-MO, MO

2d•$87,000 - $161,300•Hybrid

About The Position

The Lead Payment Integrity Systems Specialist is the senior individual contributor and enterprise-level subject-matter expert for Payment Integrity systems, platform governance, analytics, financial reporting, and operational visibility. The role sets technical and operating standards, leads complex cross-platform analysis, advises leadership, shapes prioritization decisions, and drives solutions across Operations, Technology, Finance, and governance stakeholders. Lead enterprise-level analysis of complex Payment Integrity system, claims, workflow, financial, and reporting data to identify strategic risks, prioritization decisions, savings opportunities, and operational improvement recommendations. Set standards for technical review, data validation, dashboarding, reporting routines, ServiceNow intake, defect/enhancement prioritization, UAT/release readiness, post-release issue tracking, and operational visibility. Serve as the senior business-technology liaison for platform change management, aligning Operations, Technology, Finance, governance, and leadership stakeholders on scope, impact, risk, decisions, and readiness. Own operating routines that prioritize and govern incidents, defects, enhancements, releases, automation opportunities, and modernization workstreams across Payment Integrity systems. Translate complex cross-platform results into executive-ready summaries, strategic recommendations, implementation plans, and measurable success criteria. Advise leadership on platform governance, financial reporting considerations, data quality controls, process standardization, and long-term system capability needs. Lead the design and continuous improvement of methodologies, standards, and job-family consistency across Payment Integrity system support and analytics functions. Provide technical leadership, coaching, peer review, and escalation support to PI Systems Specialist I, II, and Senior PI Systems Specialist team members. Performs other duties as assigned. Complies with all policies and standards.

Requirements

Bachelor's Degree in healthcare, business, finance, accounting, information systems, data analytics, or a related field, or equivalent experience required.
5+ years years of relevant experience in Payment Integrity systems, managed care claims systems, platform governance, financial reporting, healthcare analytics, business analysis, UAT/release readiness, or related technical healthcare function. required.
Specialized depth and/or breadth of expertise in Payment Integrity systems, claims data, operational workflows, data governance, financial reporting, system dependencies, and cross-functional transformation. required.
Advanced proficiency with SQL, reporting/analytics tools such as Power BI, financial reporting tools, Excel, ServiceNow or similar ticketing/workflow platforms, and executive-level data storytelling. required.
Demonstrated ability to lead technical direction, resolve precedent-setting issues, influence without formal authority, and communicate with senior leaders. required.
Platform Support & Governance required.
Data Validation & Reporting required.
UAT / Regression Testing required.
Defect & Enhancement Intake required.
Release Readiness required.
Financial Systems / Reporting required.
Dashboard / KPI Development required.
Configuration & Edit Support required.
Related Payment Integrity systems and technology support functions required.

Nice To Haves

Advanced knowledge of financial systems and accounting principles preferred.
Experience setting platform governance, operational visibility standards, dashboard/reporting strategy, release-readiness routines, and cross-functional technology operating models. preferred.
Advanced credentials in data analytics, business analysis, healthcare data, project/program management, Lean Six Sigma, finance/accounting, SQL, or related systems disciplines. preferred
License/Certification: LPN, RN, CPC, CPC-H, CPC-P, CCS, CCS-P, RHIT, RHIA, or CPMA. RHIT, CCS, CIC, CCDS. preferred

Responsibilities

Lead enterprise-level analysis of complex Payment Integrity system, claims, workflow, financial, and reporting data to identify strategic risks, prioritization decisions, savings opportunities, and operational improvement recommendations.
Set standards for technical review, data validation, dashboarding, reporting routines, ServiceNow intake, defect/enhancement prioritization, UAT/release readiness, post-release issue tracking, and operational visibility.
Serve as the senior business-technology liaison for platform change management, aligning Operations, Technology, Finance, governance, and leadership stakeholders on scope, impact, risk, decisions, and readiness.
Own operating routines that prioritize and govern incidents, defects, enhancements, releases, automation opportunities, and modernization workstreams across Payment Integrity systems.
Translate complex cross-platform results into executive-ready summaries, strategic recommendations, implementation plans, and measurable success criteria.
Advise leadership on platform governance, financial reporting considerations, data quality controls, process standardization, and long-term system capability needs.
Lead the design and continuous improvement of methodologies, standards, and job-family consistency across Payment Integrity system support and analytics functions.
Provide technical leadership, coaching, peer review, and escalation support to PI Systems Specialist I, II, and Senior PI Systems Specialist team members.
Performs other duties as assigned.
Complies with all policies and standards.