Manager, Special Investigation Unit (SIU)

Centene Corporation•Remote-AZ, NV

4d•$87,700 - $157,800•Remote

About The Position

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. This is a remote role within the continental US. The purpose of this position is to develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends and schemes.

Requirements

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.
Experience working with Dental and Vision plans.

Nice To Haves

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.
Medical records or coding license preferred.

Responsibilities

Monitor business processes and systems to assure integrity and compliance in billing and claims payment
Lead a team appropriately investigate all possible fraud, waste and abuse referrals
Develop educational materials to address/identify waste activities as requested by the health plan and on an ad-hoc basis
Attend state/federal meetings as required by specific contracts
Review post-payment cases with appropriate parties to obtain refund
Prepare and distribute monthly and quarterly saving reports
Participate in Appeals Committee, work groups and interdepartmental meetings