Manager, SIU Intelligence & Innovation

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.
 

• Bachelor's Degree Bachelor's degree in Data Analytics, Data Science, Business Analytics, Business or Healthcare Administration, Information Systems, Statistics, Computer Science, Criminal Justice, or a related field; or equivalent experience required.
• Master's Degree preferred.
• Juris Doctor (JD) preferred.
• 5+ years Healthcare analytics, fraud detection, SIU operations, program integrity, payment integrity, healthcare investigations, or related analytical functions required.
• 2+ years Conducting healthcare fraud investigations and knowledge of fraud, waste, and abuse trends and schemes required.
• Experience leading, mentoring, coordinating, or managing analytical resources, projects, or teams required.
• Experience developing and implementing advanced analytics, predictive monitoring, reporting, data visualization, and fraud detection methodologies using large and complex healthcare datasets to generate actionable business insights and support operational decision-making required.
• Experience collaborating with cross-functional stakeholders across operational, compliance, investigative, and analytics functions to drive data-informed strategies related to healthcare fraud, waste, and abuse prevention, managed care operations, and organizational performance improvement required.
• Experience leading healthcare analytics, SIU, Program Integrity, Payment Integrity, Compliance, or fraud, waste and abuse (FWA) initiatives, including development of analytics strategies, roadmaps, performance metrics, value realization methodologies, and operational improvement efforts preferred.
• Experience applying advanced analytics, predictive modeling, artificial intelligence, machine learning, fraud detection technologies, and external data resources to support proactive fraud identification, complex investigations, vendor and partnership oversight, and compliance with healthcare regulatory and industry requirements preferred.

• CFE, AHFI, CHC, PMP, SAS, CPC or other certifications related to healthcare fraud, analytics, investigations, project management, or data science preferred.

Centene 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