Top 340 Health net Jobs

SIU Investigator
Centene —New York, NY
- $56,200 - $101,000 a year
- Full-time
- Remote
- Mid-level
- Fair chance
- 1 year
- Paid holidays
- Health insurance
DRG Reviewer
Centene —Missouri
- $70,100 - $126,200 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid holidays
- Health insurance
SIU Investigator
Centene —Ohio
- $56,200 - $101,000 a year
- Full-time
- Remote
- Mid-level
- Fair chance
- Associate's degree
- 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
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
Actuary
Centene —Washington, DC
- $107,700 - $199,300 a year
- Full-time
- Remote
- Microsoft Excel
- 5 years
- SQL
- Paid holidays
- Health insurance
7d
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
Associate Actuary - Medicaid
Centene —Washington, DC
- $87,700 - $157,800 a year
- Full-time
- Remote
- Research
- Mid-level
- Analysis skills
- Paid holidays
- Health insurance
7d
Corporate Ethics & Compliance Investigator
Centene —Minnesota
- $107,700 - $199,300 a year
- Full-time
- Remote
- 7 years
- Management
- HIPAA
- 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
Manager, SIU Prepay Investigations
Centene —New York, NY
- $87,700 - $157,800 a year
- Full-time
- Remote
- Management
- Mid-level
- Supervising experience
- Paid holidays
- Health insurance
Director, Payment Integrity
Centene —Missouri
- $118,400 - $219,000 a year
- Full-time
- Remote
- Nursing
- 7 years
- Management
- Paid holidays
- Health insurance
4d
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 Director, Clinical Data Science
Centene —Washington, DC
- $185,700 - $352,500 a year
- Full-time
- Remote
- Computer Science
- Master's degree
- SQL
- Paid holidays
- Health insurance
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
Sr. Director, Clinical Technology Portfolio Management
Centene —Missouri
- $185,700 - $352,500 a year
- Full-time
- Remote
- 5 years
- Bachelor's degree
- US work authorization
- Paid holidays
- Health insurance
5d
Quality Practice Advisor
WellCare of Kentucky —Kentucky
- $27.02 - $48.55 an hour
- Full-time
- LMFT
- LVN
- Up to 50% travel
- Paid holidays
- Health insurance
11d
Director, Medicare Regulatory Change Management
Centene —Illinois
- $118,400 - $219,000 a year
- Full-time
- Remote
- Bachelor's degree
- Mentoring
- Contracts
- Paid holidays
- Health insurance
Associate Actuary, Strategic Analytics
Centene —Washington, DC
- $87,700 - $157,800 a year
- Full-time
- Remote
- Mid-level
- SQL
- Math
- Paid holidays
- Health insurance
Manager, Payment Integrity- Readmission
Centene —Texas
- $87,700 - $157,800 a year
- Full-time
- Remote
- Nursing
- RN License
- 3 years
- Paid holidays
- Health insurance

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SIU Investigator

Centene -
New York, NY

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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
Certified Fraud Examiner
Mid-level
Suspicious activity investigations
Data summary reports
Criminal Justice
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.

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. Strong Excel skills preferred. CFE (Certified Fraud Examiner) preferred.

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

health net jobs

SIU Investigator

DRG Reviewer

SIU Investigator

Senior Government Affairs Manager

SIU Investigator

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Senior Compliance Investigator

Associate Actuary - Medicaid

Corporate Ethics & Compliance Investigator

Senior Compliance Administrator, Medicare Claims & Payment Integrity

Manager, SIU Prepay Investigations

Director, Payment Integrity

Quality Care Member Advocate

Senior Director, Clinical Data Science

Data Analyst IV Healthcare Analytics, Medical Economics

Sr. Director, Clinical Technology Portfolio Management

Quality Practice Advisor

Director, Medicare Regulatory Change Management

Associate Actuary, Strategic Analytics

Manager, Payment Integrity- Readmission

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