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Centene Corporation

Manager, Payment Integrity Insights – Innovation

Centene Corporation

Centene manager leading fraud, waste, and abuse investigations for healthcare claims integrity. Developing compliance programs, fraud plans, and savings reporting for state and federal contracts.

Posted 8/19/2026full-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 developing and managing fraud, waste, and abuse programs while ensuring compliance with state and federal regulations. Proven ability to lead teams, conduct investigations, and prepare comprehensive reports for stakeholders.

Highest-signal resume keywords
Fraud InvestigationCompliance MonitoringTeam LeadershipMedical TerminologyManaged Care Experience

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills
Fraud ManagementClaims Payment IntegrityData AnalysisReport PreparationRFP Response ManagementEducational Material DevelopmentPost-Payment ReviewContractual ComplianceTrend AnalysisPerformance Management
Soft Skills
CommunicationLeadershipTrainingCollaborationProblem-Solving
Certifications & Qualifications
Medical Records LicenseCoding License
Industry Keywords
Fraud, Waste, and AbuseHealthcare ComplianceManaged CareMedical ClaimsState and Federal Regulations

About the role

Key responsibilities & impact
  • Develop, implement and manage strategic fraud, waste and abuse activities
  • Maintain state and federal requirements and monitor trends and schemes
  • Monitor business processes and systems for integrity and compliance in billing and claims payment
  • Lead teams of analysts investigating fraud, waste and abuse referrals
  • Develop customized fraud plans for contract and federal requirements
  • Develop educational materials to identify and validate waste activities
  • Respond to RFP requests and implement new policies per contractual obligations
  • Attend state and federal meetings as required by contracts
  • Prepare and present the FWA program to state and federal personnel
  • Review post-payment cases to obtain refunds
  • Prepare and distribute monthly and quarterly savings reports
  • Perform other duties as assigned
  • Comply with all policies and standards

Requirements

What you’ll need
  • Bachelor’s degree in Business, Healthcare, Criminal Justice, related field, or equivalent experience
  • 4+ years of medical claim investigation, compliance or fraud and abuse experience
  • Thorough knowledge of medical terminology
  • Previous experience in a managed care environment preferred
  • Previous experience as a lead or supervisor of staff, including hiring, training, assigning work and managing performance preferred
  • Medical records or coding license 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