Manager, Provider Reimbursement Audit

Centene Corporation

Centene healthcare audit manager leading Medicare, claims, and operational reimbursement audits. Managing reporting, compliance improvements, resources, and corrective actions across health plan operations.

Posted 8/18/2026full-timeRemote • Montana • 🇺🇸 United StatesMid-LevelSenior💰 $87,700 - $157,800 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in leading audit activities for Medicare, Duals, and Marketplace, with a focus on compliance, operational effectiveness, and process improvements. Proficient in managing audit reporting, resource allocation, and cross-functional collaboration to enhance claims quality.

Highest-signal resume keywords

Medicare Audit ManagementOperational Audit OversightProcess ImprovementClaims Payment SystemsAudit Reporting

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Audit ManagementOperational ComplianceData AnalysisResource AllocationProcess Improvement

Soft Skills

CommunicationTeam DevelopmentStakeholder EngagementLeadership

Tools & Technologies

MicroStrategyACLCompliance 360Microsoft ExcelMicrosoft AccessTableau

Certifications & Qualifications

CPACIACISA

Industry Keywords

MedicareDualsMarketplaceClaims AuditOperational Audits

Tech Stack

Tools & technologies

Tableau

About the role

Key responsibilities & impact

Lead a team responsible for end-to-end Medicare, Duals, and Marketplace audit activities, including planning, execution, reporting, and corrective action monitoring
Manage monthly executive reporting and communicate audit results and trends to stakeholders
Oversee resource allocation and team development
Drive process improvements that enhance quality, compliance, and operational effectiveness
Oversee operational audits across claims, provider setup and maintenance, member eligibility, contracting, encounters, provider/member services, and new business implementation
Oversee monthly claims audit management reporting
Manage the full life cycle of claims audit reporting and upstream operational audits from requirements gathering through audit closure
Manage audit work plans, schedules, resources, and budgets
Facilitate audit execution and reporting through closure of audit periods and operational audits
Communicate audit results to leadership and corporate and health plan stakeholders
Evaluate operational processes and controls to identify non-compliance and improvement opportunities
Maintain audit tools to ensure business requirements are measured during audits
Coordinate cross-functional corrective action plan meetings to support claims quality improvements

Requirements

What you’ll need

Bachelor's degree in a related field or equivalent experience
5+ years of public accounting, internal audit, or related operational experience
Knowledge of MicroStrategy, ACL, Compliance 360, Microsoft applications including Excel and Access, Tableau, and claims payment systems preferred
CPA, CIA, or CISA preferred

Benefits

Comp & perks

Competitive pay
Health insurance
401K plan
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation