You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: The SIU Program Manager role will support the organizations efforts to detect and prevent fraud and abuse by supporting the partnership with our analytics team by developing, enhancing, and adding to existing efforts to proactively identify behaviors indicative of fraudulent or abusive behavior. Additionally, this role will be tasked with developing partnerships beyond that SIU to bring a novel approach to expanding features relative to risk behaviors that support the development and value of leads that are generated for the SIU. This role will be focused on creating an increased acceptance rate of leads generated through our data analytics and reflect the capability to generate concepts or features that position the SIU to address emerging trends within healthcare and the business.
Responsibilities include:
- Lead collaborative efforts of a data analytics work group
- Coordinate and assist with layering fraud and abuse concepts into data science outcomes
- Provider regular updates to cross functional teams that highlight progress made in development and outcomes
- Develop and execute a forward-looking approach to addressing fraud and abuse
- Create partnerships with areas within the organization to pursue new opportunities that aid toward fraud and abuse identification
- Outcomes should generate value through supporting business objectives set within the SIU
- Serve as a trusted partner to the team and broader business when identifying vulnerabilities relative to fraud and abuse
- Bring a innovate and preventative mindset to fraud ideation
- Take part in internal and external opportunities to ensure awareness to changing trends within the industry
- Ensure compliance is core to the actions that are taken
- Demonstrate Centene’s core values of Accountability, Curiosity, Courage, Trust, and Service in day-to-day communications and actions
- Perform other duties as assigned
- Comply with all policies and standards
Education/Experience: Bachelor’s degree in Business Administration, Criminal Justice, Healthcare Administration, related field, or equivalent experience. Master’s degree preferred. 5+ years project implementation, product or program management experience. 5+ years in Healthcare Fraud Investigation highly preferred. Experience in developing fraud analytics preferred.
Pay Range: $86,000.00 - $154,700.00 per yearCentene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
