Manager, Special Investigation Unit (SIU)
Centene Corporation
•Hybrid
About The Position
Develop, implement and manage strategic fraud, waste and abuse activities for our Arizona and Nevada markets, as well as, Dental and Vision, by maintaining state and federal requirements and monitoring trends and schemes. Monitor business processes and systems to assure integrity and compliance in billing and claims payment.
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.
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
- 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
Benefits
- competitive pay
- health insurance
- 401K
- stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- a flexible approach to work with remote, hybrid, field or office work schedules
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Number of Employees
5,001-10,000 employees
