Top 576 Centene Jobs | SimplyHired

SIU Investigator
Centene —Florida
- $56,200 - $101,000 a year
- Full-time
- Remote
- Mid-level
- Fair chance
- 1 year
- Paid holidays
- Health insurance
Director, Quality & Process Improvement, HEDIS Audit
Centene —Remote
- $118,400 - $219,000 a year
- Full-time
- Remote
- Background check
- 6 years
- Bachelor's degree
- Paid holidays
- Health insurance
Corporate Ethics & Compliance Investigator
Centene —New York, NY
- $107,700 - $199,300 a year
- Full-time
- Remote
- 7 years
- Management
- HIPAA
- Paid holidays
- Health insurance
Senior Compliance Investigator
Centene —New York, NY
- $70,100 - $126,200 a year
- Full-time
- Remote
- Writing skills
- High school diploma or GED
- Fair chance
- Paid holidays
- Health insurance
SIU Investigator
Centene —Michigan
- $56,200 - $101,000 a year
- Full-time
- Remote
- Mid-level
- Fair chance
- Associate's degree
- Paid holidays
- Health insurance
Senior Care Manager (RN)
Meridian Michigan —Michigan
- $75,300 - $135,400 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
10d
Quality Care Member Advocate
Centene —Maine
- $27.02 - $48.55 an hour
- Full-time
- Hybrid work
- Nursing
- RN License
- Licensed Clinical Social Worker
- Paid holidays
- Health insurance
Senior Communications Specialist
Centene —Missouri
- $56,200 - $101,000 a year
- Full-time
- Remote
- Marketing
- Mid-level
- 3 years
- Paid holidays
- Health insurance
Care Manager (RN)
Centene Corporation —Michigan
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
9d
Data Analyst IV Healthcare Analytics, Medical Economics
Centene —Michigan
- $87,700 - $157,800 a year
- Full-time
- Remote
- 3 years
- Finance
- Master's degree
- Paid holidays
- Health insurance
Vice President, Clinical Technology UM Portfolio Management
Centene —Missouri
- $188,900 - $359,800 a year
- Full-time
- Remote
- 8 years
- Bachelor's degree
- Product management
- Paid holidays
- Health insurance
Senior Compliance Administrator, Medicare Claims & Payment Integrity
Centene —Illinois
- $87,700 - $157,800 a year
- Full-time
- Remote
- Master's degree
- Presentation skills
- Bachelor's degree
- Paid holidays
- Health insurance
SIU Investigator
Centene —New York, NY
- $56,200 - $101,000 a year
- Full-time
- Remote
- 5 years
- Fair chance
- Senior level
- Paid holidays
- Health insurance
Remote Medical Director, Appeals
Centene —Oregon
- $236,500 - $449,300 a year
- Weekends as needed
- Remote
- Medicine
- Fair chance
- Senior level
- Paid holidays
- Health insurance
Senior Director, Migration & Integrations
Centene —Missouri
- $185,700 - $352,500 a year
- Full-time
- Remote
- 5 years
- Bachelor's degree
- US work authorization
- Paid holidays
- Health insurance
Compliance External Audit Administrator
Centene —Florida
- $70,100 - $126,200 a year
- Full-time
- Remote
- Microsoft Office
- Travel
- SharePoint
- Paid holidays
- Health insurance
Director, Vendor Management
Sunshine State Health Plan —Florida
- $148,000 - $274,200 a year
- Full-time
- Remote
- 7 years
- Microsoft Office
- Bachelor's degree
- Paid holidays
- Health insurance
5d
Program Manager III - UM Program & Portfolio Management
Centene —Missouri
- $87,700 - $157,800 a year
- Full-time
- Remote
- 5 years
- Master's degree
- Bachelor's degree
- Paid holidays
- Health insurance
Senior Adversarial Emulation - Red Team Operator
Centene —New York, NY
- $87,000 - $161,300 a year
- Full-time
- Remote
- Computer science
- Azure
- Computer Science
- Paid holidays
- Health insurance
Utilization Review Clinician - Behavioral Health
Centene —Oregon
- $27.02 - $48.55 an hour
- Weekends as needed
- Remote
- LMFT
- Nursing
- Addiction Medicine
- Paid holidays
- Health insurance
4d

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SIU Investigator

Centene -
Florida

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Job Details

Full-time
$56,200 - $101,000 a year

Benefits

Paid holidays
Health insurance
401(k)
Tuition reimbursement
Paid time off

Qualifications

Healthcare financial misconduct investigations
Data mining
Health data analysis
Bachelor's degree in business
Mid-level
Suspicious activity investigations
Data summary reports
Criminal Justice
Audit Reporting
Investigative data analysis
Insurance investigation report preparation
Outlier detection
Healthcare billing investigations
Case referral
1 year
Insurance claims auditing
Business
Healthcare claims compliance audits
Bachelor's degree in criminal justice

Full Job Description

You could be the one who changes everything for our 28 million members. 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.

Please note: candidates who reside in Florida are highly preferred.

Position Purpose: Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse.

Conduct investigations of potential waste, abuse, and fraud
Document activity on each case and refer issues to the appropriate party
Perform data mining and analysis to detect aberrancies and outliers in claims
Develop new queries and reports to detect potential waste, abuse, and fraud
Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions
Assist with complex allegations of healthcare fraud
Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies
Complete various special projects and audits
Performs other duties as assigned
Complies with all policies and standards

Education/Experience:

Bachelor's Degree Business, Criminal Justice, Healthcare, or related field, or equivalent experience required
1+ years Medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation required

Pay Range: $56,200.00 - $101,000.00 per year

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. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Apply Now

Refine Your Search

Centene jobs

SIU Investigator

Director, Quality & Process Improvement, HEDIS Audit

Corporate Ethics & Compliance Investigator

Senior Compliance Investigator

SIU Investigator

Senior Care Manager (RN)

Quality Care Member Advocate

Senior Communications Specialist

Care Manager (RN)

Data Analyst IV Healthcare Analytics, Medical Economics

Vice President, Clinical Technology UM Portfolio Management

Senior Compliance Administrator, Medicare Claims & Payment Integrity

SIU Investigator

Remote Medical Director, Appeals

Senior Director, Migration & Integrations

Compliance External Audit Administrator

Director, Vendor Management

Program Manager III - UM Program & Portfolio Management

Senior Adversarial Emulation - Red Team Operator

Utilization Review Clinician - Behavioral Health

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