Opportunity Description
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:** Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends and schemes.
+ Monitor business processes and systems to assure integrity and compliance in billing and claims payment
+ Lead a team responsible for investigating fraud, waste and abuse referrals for prepay investigations
+ Develop educational materials to address/identify waste activities as requested by the health plan and on an ad-hoc basis
+ Attend state/federal meetings as required by specific contracts
+ Review pre-payment cases with appropriate parties for the purposes of developing resolution strategies...
**Position Purpose:** Develop, implement and manage strategic fraud, waste and abuse activities by maintaining state and federal requirements and monitoring trends and schemes.
+ Monitor business processes and systems to assure integrity and compliance in billing and claims payment
+ Lead a team responsible for investigating fraud, waste and abuse referrals for prepay investigations
+ Develop educational materials to address/identify waste activities as requested by the health plan and on an ad-hoc basis
+ Attend state/federal meetings as required by specific contracts
+ Review pre-payment cases with appropriate parties for the purposes of developing resolution strategies...
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