Centene Corporation

Compliance

• Assist in maintaining Centene Corporation’s Medical Loss Ratio Compliance Program
• Provide regulatory interpretation, perform compliance reporting, lead special projects, and develop and implement compliance medical loss ratio auditing and monitoring strategies
• Respond to external requests for information required by the organization for its medical loss ratio regulatory filings
• Manage compliance oversight or medical loss ratio reporting and assist in respond to inquiries from state and federal regulatory agencies
• Manage ethics and compliance medical loss ratio projects or implementations
• Review and synthesize regulatory requirements and create policy and/or position statements
• Communicate state and federal requirements to internal and external clients
• Provide development guidance and assist in the identification, implementation, and maintenance of compliance policies, procedures and work instructions
• Assist in the identification, analysis, and resolution of medical loss ratio compliance issues
• Maintain and review medical loss ratio regulatory documentation necessary to maintain corporate standards
• Perform periodic compliance audits, risk assessments and conducts related to ongoing compliance monitoring activities
• Assist health plans in managing relationships with regulatory agencies and seek to resolve policy issues which may negatively impact service to members
• Serve as a company-wide resource and liaison on medical loss ratio policies, contract issues and provisions, communications, workflow, and quality improvements initiatives

Senior Compliance Analyst, Medical Loss Ratio

Business Analyst

• Oversees all labor management activities of FTEs, contractors, and fixed fee resources
• Forecasts all labor changes monthly and maintains a detailed labor tracker
• Monitors actuals vs forecast each month and provides monthly updates to leadership
• Manages and administers ServiceNow reporting
• Supports process efficiency and coaches stakeholders on effective labor management practices
• Facilitates the portfolio management processes to ensure strategic alignment on technologies and goals
• Develops and monitors reporting metrics and portfolio dashboards
• Creates visibility into areas struggling with scope, schedule, resources, or budget
• Contributes to the development, management and optimization of portfolio, program, and project management methodologies
• Facilitates resource and budget planning with the IT teams on new demands
• Identifies dependencies and critical paths
• Improves and streamlines the portfolio and project lifecycle
• Identifies and resolves problems before they escalate
• Analyzes project risk profile and balance at the portfolio level
• Contributes to capacity planning for resource needs and scheduling
• Develop and maintain processes to facilitate integrated project scoping
• Maintain departmental work process for IT controls
• Analyze demand data to identify and report on trends

Senior IT Portfolio Management Analyst

• Conduct the review of and make changes to product-specific contracts and amendments between Health Plan and Material Subcontractors
• Remain up to date on all state and federal health care laws, including laws applicable to managed care industry, and on all IN Medicaid contracts and amendments
• Perform legal research and prepare memoranda regarding legislative or regulatory changes affecting the company’s vendor and/or health care provider contracts
• Coordinate SIU waste and abuse efforts with the Corporate SIU Team
• Complete all research on and file preparation for State Fair Hearings between Health Plan and State Regulatory Agency
• Represent MHS at all State Fair Hearings
• Track all outcomes and provide reports to Senior Leadership on outcomes
• Collaborate with cross-functionally to remedy MHS process issues
• Identifies issues with questionable billing providers and vendor contracts
• Tracks trends for department use and Corporate Compliance
• Escalates as required to senior management
• Coordinates department preparation for State Fair Hearings and Questionable Provider Audits (building case files, universes, evidence of compliance and other documentation as needed)
• Completes all required compliance training
• Participate in implementation of regulatory changes that span multiple departments, as needed
• Provide support and input into the development and maintenance of a consistent process for identification and escalation of issues and supporting tools; may participate in the implementation of a tool(s) for maintenance of mapping requirements/regulations to policies and procedures (P&Ps) and owners (i.e. CFR owners)
• Participate in developing and maintaining consistent processes/methods for development, implementation, communication and training on new/updated policies and procedures
• Participate with Business Units/departments with an end-to-end process orientation to ensure appropriate connectivity and handoffs are built into P&Ps that span multiple departments
• Participates in and supports other programs such as privacy and security (including HIPAA program), Ethics & Privacy, Fraud Waste & Abuse, Code of Conduct, etc.
• Performs other duties as assigned.

Business Compliance Consultant

• Perform various analysis and interpretation to link business needs and objectives for assigned function
• Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems
• Identify and analyze user requirements, procedures, and problems to improve existing processes
• Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations
• Identify ways to enhance performance management and operational reports related to new business implementation processes
• Coordinate with various business units and departments in the development and delivery of training programs
• Develop, share, and incorporate organizational best practices into business applications
• Diagnose problems and identify opportunities for process redesign and improvement
• Formulate and update departmental policies and procedures
• Serve as the subject matter expert on the assigned function product to ensure operational performance
• Ability to travel
• Performs other duties as assigned

Business Analyst III, Provider Data, SQL

Account Executive

• supports Account Executives and Account Management Teams in assigned territories for small group, mid-market, and large group segments
• assists with new business, renewal presentations and broker service issues pertaining to ancillary products
• meets or exceeds assigned annual sales goals and penetration of the book of business
• participates in product training with Sales Management for Health Plan’s commercial sales segments
• assists with supporting Health Plan’s General Agents and brokers in assigned territory
• develops best practices and works to implement those based on local market conditions
• reviews and responds to RFP’s, manages internal strategy, and participates in major sales and renewal presentations
• maintains competitive analysis information and submits to sales management quarterly
• builds relationships with Health Plan sales and account management teams to increase new sales and penetrate Health Plan’s book of business
• travels to customer, finalist and presale meetings, and other cross-sale related activities
• submits Account Executive reports and ad hoc reports upon request and in a timely manner
• complies with all policies and standards

Account Executive II – Medicare Programs

Operations

• Oversee operations and business strategy utilizing cross-functional departments to meet strategic objectives
• Develop and manage methodologies for tracking, identifying and problem-solving issues
• Collaborate with staff to identify internal and external customers and their expectations
• Facilitate and support operations staff in the planning, achievement, and tracking of the organization's key strategic initiatives
• Serve as an internal resource and advisor on improvement activities
• Explore new approaches to work processes by utilizing quality improvement techniques to eliminate waste and re-work
• Able to travel up to 25%

Operations Manager

Artificial Intelligence

• Ensures the organization's responsible and compliant use of artificial intelligence (AI)
• Collaborates with various departments and stakeholders to promote a culture of AI compliance
• Ensures fairness, transparency, and accountability in AI systems across the organization
• Mitigate potential biases and discriminatory outcomes, fostering trust with members and the public
• Establishes and maintains a comprehensive AI compliance program that aligns with organizational goals, legal requirements, and ethical standards
• Develops and implements AI-specific policies and procedures
• Conducts AI risk assessments to identify potential compliance risks associated with AI applications
• Develops and maintains a centralized inventory of all AI models and solutions used across the organization
• Oversees the selection and management of third-party vendors providing AI solutions
• Maintains current knowledge of applicable AI-related regulations and government policies
• Monitors and audits compliance with AI governance policies and procedures
• Collaborates with legal counsel on AI-related matters
• Develops and delivers AI compliance training and awareness programs for employees and stakeholders

Director, Artificial Intelligence – Compliance

Financial Planning and Analysis

• Maintain the Network QAI (Quality and Healthcare Affordability Initiatives) portfolio workflow in Planview including initiative detail and financial entries
• Lifecycle tracking, data extracts, custom reporting, Power BI reporting, and other ad hoc requests for information
• Collaboration with Network QAI (Quality and Healthcare Affordability Initiatives) partners including GSD (Governance and Strategy Deployment) support teams, product teams, health plans, and network reimbursement/ contracting subject matter expert teams
• Identify trends and developments in competitive environments and present findings to senior management
• Develop integrated revenue/expense analyses, projections, reports, and presentations

Finance Analyst III – Network Reimbursement

Systems Engineer

• Responsible for ensuring the optimization of the organization’s Digital Employee Experience (DEX) solutions
• Managing incident escalations and resolving solution outages to minimize business disruption and maximize productivity
• Provides direct support and guidance to peers in troubleshooting endpoint related incidents and outages
• Work closely with peer endpoint teams on root cause analysis of endpoint issues and build long term preventive solutions
• Provide occasional after-hours support to critical issues and outages
• Implement the DEX Strategy that drives continuous improvements of the end user compute experience
• Support planned and unplanned reporting efforts on status updates to senior and executive leadership
• Coordinate problem and incident management with 3rd party vendors
• Mentor, and coach peer multidisciplinary system engineers, foster a culture of innovation, accountability, and continuous improvement
• Collaborate with Product Owners, Customer Success, Architecture, stakeholders, and cross-functional teams to prioritize backlogs and align engineering efforts with business objectives
• Manage the escalation process for critical incidents and solution outages related to End User Technologies, ensuring timely resolution and effective communication with stakeholders
• Establish and refine incident management procedures, including root cause analysis and post-mortem reviews to prevent recurrence
• Coordinate with support teams, vendors, and other IT functions to address complex technical issues and restore services efficiently
• Use monitoring and reporting to identify, track and trend endpoint related performance issues impacting end users and DEX score
• Identify opportunities to automate processes, reduce manual effort, document procedures, and increase the reliability of End User Technologies
• Stay informed of industry trends, emerging technologies, and best practices to drive innovation within the DEX domain

Senior Systems Engineer – Digital Employee Experience

Project Manager

• Learn more about Centene and how we're transforming the health of the community
• Be involved with project support and internal stakeholder relationship management
• Shadow active projects and support project planning
• Research various legal, regulatory, and other topics within functional area and industry
• Attend training and development presentations to enhance professional competencies

Project Management Intern, Undergraduate

Auditor

• Perform complex internal audits, including the execution of strategic, operational, financial, IT, and compliance risk-based audits for the entire company and its subsidiaries
• Design, perform, and manage risk-based audits, including evaluating controls and processes for scalability, effectiveness, efficiency, and risk mitigation strategies
• Perform audit planning, fieldwork, and wrap-up of engagements, including development and refinement of work programs
• Assist in drafting audit reports, including summarizing key findings and recommendations and consolidation of metrics and graphing
• Develop and communicate audit observations, recommendations, process improvement opportunities, and best practices and obtain management responses
• Monitor and report on the status and findings of audits
• Serve as contact for corporate, field, and external auditors regarding auditing, fraud matters, and projects
• Work with external professionals and specialists to complete audits/projects
• Collaborate with team members to ensure coordination, timely documentation, and adherence to audit methodology throughout the engagement
• Develop and clearly communicate audit observations, recommendations, and best practices; obtain management responses and support department-level process improvement initiatives.

Senior Internal Auditor

• Develop strategic partnerships between the health plan and the contracted provider networks serving our communities
• Cultivate client relations and collaborate with providers to ensure delivery of the highest level of care to our members
• Participate in the development of network management strategies
• Creates strategic initiatives for performance improvement
• Serve as a strategic partner/primary contact for hospital systems, multi-specialty groups, and large PCP groups with Value Based/Risk Components
• Executes provider performance improvement strategies in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
• Builds strong interpersonal relationships with cross functional teams both externally (provider) and internally (health plan)-C-suite Level
• Resolve provider issues as needed for resolution to internal partners and creating efficiencies to prevent continued concerns
• Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
• Evaluates provider performance and develops strategic plan to improve performance
• Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)
• Acts as a lead for the external representatives
• Coaches and trains external representatives
• Ability to travel locally 4 days a week

Provider Engagement Account Executive

Human Resources

• Assist the Director of E&C (ICHRA) with building and implementing the Individual Coverage Health Reimbursement Arrangement (ICHRA) compliance program
• Serve as a ICHRA subject matter expert and compliance liaison to the business
• Assist with regulatory interpretation, manage compliance reporting, lead special projects
• Develop and implement compliance auditing and monitoring strategies
• Manage internal compliance risk assessment process for ICHRA
• Respond to external requests for information required by the organization for its regulatory filings
• Monitor pending legislation and regulations

Compliance Analyst – ICHRA

Crypto

• Responsible for overseeing the enterprise-wide Digital Asset Management (DAM) platform
• Manage system configuration, integrations, and performance while establishing governance frameworks for metadata, taxonomy, and user access
• Collaborate with cross-functional stakeholders to enforce best practices, optimize workflows, and drive adoption
• Govern the intake process and promote high-priority content as requested by Line of Business and stakeholders
• Establish user intuitive asset access HUB model to point users to the assets that they need
• Infuse automation and drive efficiency by removing manual on-line/off-line ways of working
• Accountable for precise user on-boarding, training, and fostering a user community of expertise
• Maintain and configure the DAM platform, ensuring uptime, security, and performance
• Manage integrations with other enterprise systems (e.g., CMS, PIM, marketing automation)
• Oversee upgrades, patches, and vendor relationships
• Develop and enforce metadata standards, taxonomy, and asset lifecycle policies
• Ensure compliance with copyright, licensing, and brand guidelines
• Implement user access controls and permissions
• Design and optimize asset ingestion, tagging, and retrieval workflows
• Monitor and report on system usage and adoption metrics
• Partner with marketing, creative, BTS, and other teams to align DAM strategy with business needs
• Provide training and support for DAM users across the organization
• Act as the primary point of contact for DAM-related inquiries and enhancements

Digital Asset Management Platform Manager

Medical Director

• Provide people leadership, coaching and mentorship for a team of front-line medical directors
• Support Chief Medical Officer in the execution of strategic clinical initiatives
• Participate in utilization review studies, evaluate adverse trends; and collaborate with CMO to develop solutions
• Handle complex and high-profile utilization management cases
• Conduct regular rounds to assess and coordinate care for high-risk patients
• Oversee and actively participate in the appeals process
• Collaborate closely with clinical teams, appeals team, and network providers to ensure understanding and adherence to utilization management policies