Centene Corporation

Director

• Oversee prepay waste and abuse reviews through coding, editing, and audit programs
• Provide guidance and set policies to ensure all programs adhere to state and federal regulations as well as company policies
• Oversee prepay editing and retrospective audits to ensure accurate and timely payments of coding and pricing issues
• Interpret audit results, develop action plans and present findings to senior management
• Develop and implement continuous processes from analytic design to final report stage
• Design, develop, and implement internal payment integrity edit and audit programs, policies, and procedures
• Monitor laws and regulations that may impact payment integrity policies and procedures and implement changes while maintaining compliance with all state and federal regulations
• Recommend process improvement to assist in developing and executing strategic initiatives and goals
• Develop and deliver educational training programs to providers and employees to streamline operational processes and ensure accurate coding
• Direct and lead Prepay Compliance Managers in their efforts to reduce waste, abuse, and fraud
• Performs other duties as assigned
• Complies with all policies and standards

Director, Payment Integrity

Claims Specialist

• Assist in coordinating the day-to-day work function of the assigned claims unit
• Provide technical support to staff
• Investigate, review and resolve complex issues
• Provide oversight to ensure payments and/or denials are made in accordance with company practices and procedures
• Ensure Claims Analysts apply policy and provider contract provisions to determine claim payability
• Train, mentor and develop claims analysts as reinforcement of claims training
• Assist in reviewing, investigating, adjusting, and resolving all pending claims, especially complex claims
• Serve as first point of escalation
• Monitor claims quality reviews for accuracy, document results and identify trends
• Assist in creating workflows for the department
• Primary contact for the team, for the plan and for other departments
• Maintain appropriate records, files, documentation, etc.
• Meet and maintain department production and quality standards

Lead Claims Analyst

Artificial Intelligence

• Supports the implementation and expansion of our AI Governance program
• Serves as a critical advisor on the ethical implications of AI systems, translating advanced ethical theory and research into practical, operational guidance
• Ensures AI initiatives align with societal values, regulatory expectations, and the organization's commitments to responsible and trustworthy AI
• Conducts rigorous ethical reviews and risk assessments of AI systems throughout their lifecycle, from conception through deployment, applying advanced ethical frameworks and methodologies to identify potential harms, unintended consequences, and systemic risks across diverse use cases and populations
• Partners with product teams, engineers, data scientists, and business leaders to embed ethical requirements into AI design, development, and deployment, ensuring ethical considerations are operationalized in technical and business decisions
• Designs and maintains tools, frameworks, and decision support resources that translate ethical theory into applied, repeatable governance practices
• Translates complex, abstract ethical principles into concrete, actionable guidance suitable for technical, legal, compliance, and business audiences
• Expands and refines enterprise AI ethics frameworks, policies, and standards to address emerging technologies, novel use cases, and evolving regulatory expectations
• Develops healthcare specific and use case specific ethical guidance that reflects domain complexity, regulatory scrutiny, and real world operational constraints
• Serves as a recognized subject matter expert on AI ethics, providing expert judgment on complex ethical dilemmas related to fairness, transparency, accountability, privacy, explainability, and human autonomy
• Monitors and interprets evolving regulatory developments, standards, and industry best practices to inform policy updates and governance decisions; proactively identify emerging ethical challenges related to AI, including bias, surveillance, and societal impact
• Facilitates ethics discussions, workshops, training programs, and deliberative forums with cross functional stakeholders, building organizational capability and maturity in responsible AI practices
• Performs other duties as assigned
• Complies with all policies and standards

AI Ethicist – Artificial Intelligence

Compliance

• Serves as a strategic compliance leader and subject matter expert responsible for overseeing and advancing the Medicare Compliance Program
• Provides trusted advisory support to business and compliance leadership by interpreting regulatory guidance
• Leads compliance strategy execution, regulatory interactions, risk mitigation activities, and continuous improvement initiatives
• Develops, implements, and oversees compliance strategies, policies, and processes that promote ethical conduct
• Identifies regulatory risks, analyzes trends, escalates issues, oversees corrective action plans, and contributes to risk assessments and auditing activities
• Partners with cross functional stakeholders to embed compliance requirements into business processes
• Supports compliance training and education initiatives for employees, leadership, and FDRs

Senior Manager, Medicare Compliance Advisory – Part C

Analyst

• Perform day to day duties and testing of contract implementation, including UAT to ensure that systems accurately reflect a contract's negotiated terms
• Perform audits of provider setup within the provider information system to ensure accurate contract implementation and subsequent claims processing
• Review and price contract related pends to ensure claims payment accuracy
• Ensure accurate contract implementation and subsequent claims processing through provider setup, UAT testing, etc. on basic Change Requests (CRs)
• Troubleshoot and problem solve contract implementation issues related to basic system configuration
• Review contracts and assign pay classes and applicable provider information based on contract language
• Assist with the internal communication of all new and revised material contract terms and provisions to all affected departments
• Review new and current provider contracts and established state guidelines
• Participate in determining the appropriate configuration of the claims payment process

Contract Implementation Analyst

• processing of all commission related payments, accounting entries and reports for the broker network
• performs data reconciliation, research commission related payment
• provides assistance to other team members on new accounts and difficult issues
• prepares scheduled and month-end reports
• provides analytical support by identifying issues with commission payments
• reviews month-end reports and performs reconciliations and report balancing
• interacts with broker and sales force to provide customer support on commissions/related inquiries
• develops and implements training modules for new hires or cross-training efforts

Commissions Analyst I

Manager

• Provides strategic leadership across the Health Plan Concierge vertical, overseeing market engagement, provider alignment, escalation management, and cross-functional coordination
• Leads teams that address provider and market needs, resolves issues effectively, and ensures market insights inform Payment Integrity priorities
• Directs forums and taskforces that translate experience signals into actionable priorities, supporting claims accuracy, reduced improper payments, and improved financial performance
• Partners with business, clinical, legal, compliance, technology, and network leaders to deliver effective provider education, strengthen governance, and drive adoption of initiatives that support sustainable medical cost savings and enterprise operational excellence
• Provides operational and strategic leadership for Payment Integrity activities within an assigned line of business, supporting market-facing efforts such as provider engagement, issue resolution, escalation management, communications and cross-functional coordination
• Executes program strategies that reduce improper payments, enhance claims accuracy, and support financial and operational objectives for the assigned business segment, ensuring alignment with broader enterprise PI goals
• Implements and maintains governance processes, controls, documentation standards, and performance measures that uphold accuracy, compliance, and operational integrity within the line of business
• Collaborates with partners across Claims, Clinical, Finance, Compliance, Provider Relations, Network, Legal, IT, and Health Plan teams to address systemic issues, resolve escalations, improve workflows, and enhance provider and member experience
• Leads insight-generation and analytics activities for the assigned line of business identifying provider pain points, operational risks, emerging trends, and opportunities to improve payment accuracy and prevent issue
• Directs provider education and communication efforts by delivering clear, consistent messaging tied to PI edits, audits, policies, and process changes and supporting successful adoption across internal and external stakeholders
• Oversees activities related to resolving complex provider issues, including coordinating supporting documentation, clarifying program requirements, and collaborating with internal partners to ensure timely and accurate case management
• Ensures compliance with CMS, Medicaid, Medicare, state regulatory requirements, coding and documentation standards, and all applicable policies, applying enterprise guidance to the unique needs of the assigned line of business
• Presents program performance, provider issue themes, savings outcomes, and risk mitigation strategies to inform prioritization, governance decisions and organizational planning
• Performs other duties as assigned

Senior Manager, Payment Integrity – Health Plan Concierge

Data Analyst

• Analyze integrated and extensive datasets to extract value, impacting business decisions
• Collaborate with stakeholders to identify areas of value, develop solutions, and deliver insights
• Analyze and run complex reports, understand financial drivers and cost trends
• Optimize medical spend while maintaining quality of care
• Interpret and analyze data from multiple sources including healthcare provider, member/patient, and third-party data
• Lead planning and execution of large-scale projects and new reporting tools
• Identify and resolve data, process, and technical issues
• Communicate findings and insights verbally and visually to non-technical business partners
• Independently engage with business leaders to understand market-specific levers and constraints
• Leverage enterprise reporting tools to deliver data-driven insights and recommendations
• Research key business problems and identify opportunities through quantitative analysis
• Communicate and present data-driven insights to internal and external stakeholders
• Mentor junior analysts on analytic best practices

Data Analyst IV, Healthcare Analytics, Medical Economics

• Assists in developing, assessing, and coordinating holistic care management activities
• May develop or assist with developing personalized service care plans and educate members and their families/caregivers
• Evaluates member needs, resources available, and recommends plans for the best outcome
• Monitors care plans, member status, and outcomes as appropriate
• Interacts with long-term care healthcare providers to ensure member needs are met
• Provides education to long-term care members and their families/caregivers

LTSS Service Care Manager

Systems Engineer

• design, build, test and maintain enablers of business processes
• contribute to the entire implementation process
• drive definition of improvements based on business need and architectural improvements
• responsible for build and test, root cause analysis, and complex performance tuning
• consult with users to identify current operating procedures and to clarify program objectives
• may be expected to write documentation to describe program development, logic, coding, and corrections
• write manuals for users to describe installation and operating procedures

Business Systems Analyst – Medicare Enrollment Processing

Marketing

• Lead key strategic programs for the Marketing organization and assigned lines of business
• Drive strategy and lead best-in-class, insight driven marketing activities to drive impact at a national and local level
• Guide and implement the annual marketing plans to grow member acquisition and retention in the assigned territory
• Execute multichannel marketing activations relevant for the geographies that align with the investment and resource allocation plan
• Serves as project leader for larger scale, cross-functional initiatives that are intended to drive member enrollment and retention
• Leads cross-functional work teams to accomplish marketing project work
• Owns marketing relationships within the assigned line of business
• Prepares communications, reports, and presentations to all levels of the organization
• Develops and adapts marketing content activations so that they are relevant and accessible to all audiences
• Provides thought leadership pertaining to current industry trends

Senior Marketing Manager

General Counsel

• Serve as a legal counselor to Centene business leaders, providing strategic legal input and guidance.
• Partner with business leaders to develop solutions to legal problems and challenges.
• Takes on increasing responsibility for national-level and/or Company-wide legal matters.
• Provides legal advice to Centene entities and develops solutions to legal and regulatory requirements that impact various product lines and programs.
• Serves as primary counsel supporting various Centene business functions.
• Advises corporate teams with solving business challenges.
• Develops and recommends legal structures for business opportunities.
• Manages outside counsel as necessary to ensure the delivery of efficient legal services.

Vice President, Associate General Counsel

Customer Support

• Serves as the first-line advocate that focuses on resolving inquiries, issues, or concerns for members and/or providers
• Leverages a variety of communication channels to provide members and/or providers with timely, accurate, and personalized support on routine complaints
• Receives and responds to routine member and/or provider inquiries, requests and/or concerns in an accurate and timely manner
• Mitigates and prevents complaints from being escalated to resolve in initial contact
• Serves as the front-line resolution advocate on various member and/or provider inquiries, requests, or concerns
• Resolves basic problems by communicating the requested information regarding the assessment of the member or provider needs, understanding the cause, and determining if problems need to be routed to other departments for further resolution
• Maintains performance and quality standards based on established contact center metrics
• Provides customer service in a high pace contact center environment over the phone, via live chats and emails
• Documents all member or provider information and communications for quality and performance tracking through the Customer Relationship Management (CRM) applications
• Remains up-to-date and adheres to quality standards, regulation, and all other policies to ensure quality, consistency, and compliance
• Performs other duties as assigned
• Complies with all policies and standards

Customer Service Advocate

Business Analyst

• Evaluate and analyze benefit configuration processes, initiatives, and requirements.
• Design, develop, and maintain training materials and documentation to support benefit configuration and compliance requirements.
• Analyze technical applications and employee readiness requirements and determine appropriate learning applications.
• Develop instructional templates, work processes, and distribute guidelines to increase productivity.
• Collaborate with subject matter experts to ensure accuracy of documentation.
• Manage the training evaluations process and provide feedback to ensure training performance objectives are met.

Senior Business Process Analyst

Cloud Engineer

• Manages the technical approach and decisions as it relates to the configuration of software and infrastructure services on the cloud platform
• Manages cloud infrastructure as code
• Automates deployment and administration
• Develops plan to ensure security of cloud components
• Partners with the DevOps team to spearhead and lead upgrades, enhancements, and software migrations
• Leads projects and teams of cloud engineers who build and support the administration of cloud-based environments
• Establishes and develops code-based CI/CD deployment standards and best-practices
• Leads and directs the implementation of monitoring solutions
• Articulates platform infrastructure best practices
• Mentors and impacts relevant operational and build teams
• Ensures the execution and completion of capacity plans to include cloud-based deployments
• Delivers continuous integration and delivery pipeline and standards
• Facilitates people management and resourcing