Top 555 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
SIU Investigator
Centene —Kentucky
- $56,200 - $101,000 a year
- Full-time
- Remote
- Mid-level
- Fair chance
- Associate'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
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
Inpatient Utilization Review Clinician, Behavioral Health
Centene —Louisiana
- $27.02 - $48.55 an hour
- Full-time
- Remote
- LMFT
- Nursing
- Addiction Medicine
- Paid holidays
- Health insurance
Provider Reimbursement Specialist
Fidelis Care —New York, NY
- $56,200 - $101,000 a year
- Full-time
- Remote
- Research
- Mid-level
- Analysis skills
- Paid holidays
- Health insurance
Manager, Sales Investigations
Centene —North Carolina
- $87,700 - $157,800 a year
- Full-time
- Remote
- High school diploma or GED
- Fair chance
- 1 year
- 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
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
Quality Trainer I
Centene —Florida
- $56,200 - $101,000 a year
- Full-time
- Remote
- Research
- Mid-level
- Bachelor's degree
- Paid holidays
- Health insurance
12d
Chief Medical Officer
Fidelis Care —New York, NY
- $276,400 - $525,800 a year
- Full-time
- Remote
- Medicine
- 7 years
- BC/BE
- Paid holidays
- Health insurance
Senior Government Affairs Manager
Centene —Washington, DC
- $107,700 - $199,300 a year
- Full-time
- Hybrid work
- 5 years
- Office
- Bachelor's degree
- Paid holidays
- Health insurance
Psychologist Reviewer
Centene —California
- $87,700 - $157,800 a year
- Full-time
- Remote
- Addiction Medicine
- Mid-level
- Outpatient experience
- Paid holidays
- Health insurance
14d
Senior HEDIS Quality & Audit Analyst
Centene —Remote
- $70,100 - $126,200 a year
- Full-time
- Remote
- Background check
- Master's degree
- Bachelor's degree
- Paid holidays
- Health insurance
Quick Apply
Senior Director, Pharmacy
Centene Pharmacy Services —California
- $185,700 - $352,500 a year
- Full-time
- Remote
- Driver's License
- Bachelor's degree
- Team management
- Paid holidays
- Health insurance
Actuary
Centene —North Carolina
- $107,700 - $199,300 a year
- Full-time
- Remote
- Microsoft Excel
- 5 years
- SQL
- Paid holidays
- Health insurance
LTSS Service Care Coordinator
Meridian Illinois —Barrington, IL
- $22.94 - $38.79 an hour
- Full-time
- Hybrid work
- Nursing
- Up to 50% travel
- RN License
- Paid holidays
- Health insurance
14d
Director, Supplemental Benefit Implementation
Centene —Missouri
- $148,000 - $274,200 a year
- Full-time
- Remote
- 5 years
- Bachelor's degree
- Fair chance
- Paid holidays
- Health insurance
9d
Senior Business Technical Analyst
Centene —Missouri
- $87,700 - $157,800 a year
- Full-time
- Remote
- Computer Science
- Research
- Master's degree
- Paid holidays
- Health insurance
10d
Privacy & Security Enterprise Engagement Officer
Centene —Florida
- $107,700 - $199,300 a year
- Full-time
- Remote
- HIPAA
- Master's degree
- Bachelor's degree
- Paid holidays
- Health insurance

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SIU Investigator

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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

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Refine Your Search

Centene jobs

SIU Investigator

SIU Investigator

Corporate Ethics & Compliance Investigator

Director, Quality & Process Improvement, HEDIS Audit

Inpatient Utilization Review Clinician, Behavioral Health

Provider Reimbursement Specialist

Manager, Sales Investigations

SIU Investigator

Senior Compliance Investigator

Quality Trainer I

Chief Medical Officer

Senior Government Affairs Manager

Psychologist Reviewer

Senior HEDIS Quality & Audit Analyst

Senior Director, Pharmacy

Actuary

LTSS Service Care Coordinator

Director, Supplemental Benefit Implementation

Senior Business Technical Analyst

Privacy & Security Enterprise Engagement Officer

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