Manager, SIU Prepay Investigations

Centene Corporation

Manager overseeing strategic fraud, waste and abuse investigations at Centene. Championing compliance and integrity in healthcare billing and claims for millions of members.

Posted 6/5/2026full-timeRemote • Florida, Montana, New York, Tennessee • 🇺🇸 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 by maintaining state and federal requirements and monitoring trends and schemes
Monitor business processes and systems to assure integrity and compliance in billing and claims payment
Lead a team responsible for investigating fraud, waste and abuse referrals for prepay investigations
Develop educational materials to address/identify waste activities as requested by the health plan and on an ad-hoc basis
Attend state/federal meetings as required by specific contracts
Review pre-payment cases with appropriate parties for the purposes of developing resolution strategies
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 as a lead or supervisor in a pre-payment process managing cross functional teams or supervisory experience including hiring, training, assigning work and managing the performance of staff preferred
Knowledge of Microsoft Excel, medical coding, claims processing, and data mining 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 miningpre-payment process

Soft Skills

leadershipteam managementcommunicationtrainingperformance managementstrategic developmentproblem-solvingorganizational skillscollaborationeducational material development

Certifications

Bachelor’s degree