Investigation Quality Audit Analyst
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: Kansas • Missouri • United States
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Salary
💰 $56,200 - $101,000 per year
About the role
- Ensures the integrity, quality, and compliance of healthcare investigations through audits, process improvements, and collaboration with investigative teams.
- Combines analytical review, training, reporting, and some policy development to support organizational goals and regulatory standards.
- Conduct regular audits of Special Investigation Unit (SIU) and Compliance Investigation Unit (CIU) investigative case documentation and notes to ensure compliance.
- Assist in identification of trends, discrepancies, or potential areas of risk, providing actionable items to leadership.
- Develop and maintain audit tools, scorecards, and tracking systems.
- Collaborate with Investigative teams and leadership to address audit findings and implement remediation plans.
- Monitor implementation of process changes to ensure sustained compliance and improved quality outcomes.
- Provide feedback and support to investigative leadership on documentation requirements, best practices, and quality standards.
- Participate in training sessions to support ongoing staff education related to compliance and investigation excellence.
- Prepare audit reports and present findings to management with clear insights and recommendations.
- Track performance metrics, compliance trends, and improvement initiatives to measure program effectiveness.
Requirements
- Bachelor's Degree in Business, Criminal Justice, Healthcare, related field or equivalent experience required.
- 3+ years experience in medical claim investigation, medical claim audit, medical claim analysis, SIU functions or healthcare fraud investigation.
- 2+ years with a relevant certification (CFE, AHFI, CIA, CHC, CPC or CPMA) required.
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
auditingprocess improvementanalytical reviewpolicy developmentreportingtrend analysisrisk identificationaudit toolsscorecardstracking systems
Soft Skills
collaborationcommunicationleadershiptrainingfeedbackpresentation skillsproblem-solvingattention to detailorganizational skillscritical thinking
Certifications
CFEAHFICIACHCCPCCPMA