Manager, Special Investigation Unit – SIU

Centene Corporation

Manager of fraud, waste, and abuse activities while ensuring compliance for Arizona and Nevada markets. Leading investigations, developing educational materials, and reporting on savings for healthcare operations.

Posted 4/28/2026full-timeRemote • Arizona, Nevada • 🇺🇸 United StatesMid-LevelSenior💰 $87,700 - $157,800 per yearWebsite

About the role

Key responsibilities & impact

Develop, implement and manage strategic fraud, waste and abuse activities for our Arizona and Nevada markets
Monitor business processes and systems to assure integrity and compliance in billing and claims payment
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
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

Requirements

What you’ll need

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
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

Benefits

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

medical claim investigationfinancial impact analysisbusiness analysiscompliancefraud and abusemedical terminologymedical codingclaims processingdata mining

Soft Skills

leadershipteam managementcommunicationtrainingperformance management

Certifications

medical records licensecoding license