Centene Corp

Lead Payment Integrity Systems Specialist

Centene Corp • $87K — $161K *
US-Anywhere
+ 5 other locationsRemote
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's Degree in healthcare, business, finance, accounting, information systems, data analytics, or related field, or equivalent experience.
  • 5+ years of relevant experience in Payment Integrity systems, managed care claims systems, or related technical healthcare functions.
  • Advanced proficiency with SQL, Power BI, Excel, and ServiceNow or similar platforms.
  • Demonstrated ability to lead technical direction and influence senior leaders without formal authority.
  • Specialized expertise in Payment Integrity systems, claims data, and operational workflows.

Responsibilities

  • Lead enterprise-level analysis of Payment Integrity systems and data to identify risks and improvement opportunities.
  • Set standards for data validation, reporting routines, and operational visibility.
  • Serve as the senior liaison for platform change management across multiple stakeholders.
  • Own routines that prioritize incidents, defects, and enhancements in Payment Integrity systems.
  • Translate complex data results into executive-ready summaries and strategic recommendations.
  • Advise leadership on platform governance and long-term system capability needs.
  • Lead the design and improvement of methodologies and standards for Payment Integrity support.

Benefits

  • Comprehensive health insurance options.
  • Retirement savings plan with company match.
  • Professional development opportunities and training.
  • Flexible work arrangements.
  • Employee wellness programs.
Full Job Description
Position Purpose: The Lead Payment Integrity Systems Specialist is the senior individual contributor and enterprise-level subject-matter expert for Payment Integrity systems, platform governance, analytics, financial reporting, and operational visibility. The role sets technical and operating standards, leads complex cross-platform analysis, advises leadership, shapes prioritization decisions, and drives solutions across Operations, Technology, Finance, and governance stakeholders.
  • Lead enterprise-level analysis of complex Payment Integrity system, claims, workflow, financial, and reporting data to identify strategic risks, prioritization decisions, savings opportunities, and operational improvement recommendations.
  • Set standards for technical review, data validation, dashboarding, reporting routines, ServiceNow intake, defect/enhancement prioritization, UAT/release readiness, post-release issue tracking, and operational visibility.
  • Serve as the senior business-technology liaison for platform change management, aligning Operations, Technology, Finance, governance, and leadership stakeholders on scope, impact, risk, decisions, and readiness.
  • Own operating routines that prioritize and govern incidents, defects, enhancements, releases, automation opportunities, and modernization workstreams across Payment Integrity systems.
  • Translate complex cross-platform results into executive-ready summaries, strategic recommendations, implementation plans, and measurable success criteria.
  • Advise leadership on platform governance, financial reporting considerations, data quality controls, process standardization, and long-term system capability needs.
  • Lead the design and continuous improvement of methodologies, standards, and job-family consistency across Payment Integrity system support and analytics functions.
  • Provide technical leadership, coaching, peer review, and escalation support to PI Systems Specialist I, II, and Senior PI Systems Specialist team members.
  • Performs other duties as assigned.
  • Complies with all policies and standards.

Education/Experience:
Bachelor's Degree in healthcare, business, finance, accounting, information systems, data analytics, or a related field, or equivalent experience required.
5+ years years of relevant experience in Payment Integrity systems, managed care claims systems, platform governance, financial reporting, healthcare analytics, business analysis, UAT/release readiness, or related technical healthcare function. required.
Specialized depth and/or breadth of expertise in Payment Integrity systems, claims data, operational workflows, data governance, financial reporting, system dependencies, and cross-functional transformation. required.
Advanced proficiency with SQL, reporting/analytics tools such as Power BI, financial reporting tools, Excel, ServiceNow or similar ticketing/workflow platforms, and executive-level data storytelling. required.
Demonstrated ability to lead technical direction, resolve precedent-setting issues, influence without formal authority, and communicate with senior leaders. required.
Platform Support & Governance required.
Data Validation & Reporting required.
UAT / Regression Testing required.
Defect & Enhancement Intake required.
Release Readiness required.
Financial Systems / Reporting required.
Dashboard / KPI Development required.
Configuration & Edit Support required.
Related Payment Integrity systems and technology support functions required.
Advanced knowledge of financial systems and accounting principles preferred. preferred.
Experience setting platform governance, operational visibility standards, dashboard/reporting strategy, release-readiness routines, and cross-functional technology operating models. preferred.

License/Certification:

  • Advanced credentials in data analytics, business analysis, healthcare data, project/program management, Lean Six Sigma, finance/accounting, SQL, or related systems disciplines. preferred
  • License/Certification: LPN, RN, CPC, CPC-H, CPC-P, CCS, CCS-P, RHIT, RHIA, or CPMA. RHIT, CCS, CIC, CCDS. preferred

Pay Range: $87,000.00 - $161,300.00 per year

About Centene Corp

Centene Corporation is a managed healthcare enterprise at the forefront of innovation and growth for government-sponsored and commercial healthcare, providing access to fully integrated, high-quality, and cost-effective services that help people lead healthier lives. The company’s local approach addresses the needs of under-insured and uninsured individuals who often lack the resources required to sustain optimal health and wellness. Centene began as a single health plan in Milwaukee, Wisconsin in 1984. After an initial period of growth, Michael Neidorff joined as President and Chief Executive Officer (CEO) in 1996, moving Centene’s headquarters to St. Louis, Missouri, where it still resides today. In the decades since its humble beginnings, Centene has transformed into a publicly-traded Fortune 500 company serving communities across the United States. In fact, Centene provides coverage in all 50 U.S. states. More than 26 million Americans rely on Centene to access a wide range of insurance solutions, including Medicaid, Medicare, TRICARE, correctional, and behavioral health services. Centene prioritizes the development of technology that addresses systemic conditions impacting the whole health needs of underserved populations. As technology plays an increasingly critical role in diagnosing, managing, and treating disease, Centene understands that it enables better health outcomes for members, lessening the burden for providers, and allowing more automation and efficiency for business operations. As a steward of a significant set of data and insights, Centene leverages this data to not only shape but lead the digital transformation of healthcare and improve the patient-provider experience. Centene’s current CEO, Sarah London, and her team are leading the charge in this new age. Sarah London worked within Centene’s Technology Innovation and Modernization division, spearheading the company’s enterprise-wide technology strategy. Now leading Centene, her focus is on building the next generation of products and services and establishing Centene’s long-term growth and value creation. Although Centene has grown into the No. 1 insurer in the U.S. Health Insurance Marketplace, it has never lost its focus on the individual or its passion for community health. Remaining connected to the individuals and families that need care most is central to Centene’s commitment to shaping a better world of healthcare for the communities it serves. Centene also remains connected to the needs of its employees, who make Centene what it is. Through its commitment to diversity, equity, and inclusion practices, Centene promotes a safe and inviting environment above all. Because of Centene’s commitment to excellence and progression in the healthcare industry, it has been recognized as a Top Organization for Diversity by Modern Healthcare magazine, a Leading Disability Employer by the National Organization on Disability, a Best Place to Work for LGBTQ Equality by The Human Rights Campaign Foundation, and a global leader by Bloomberg’s Gender-Equality Index, among many other recognitions. Centene was also named a Top 50 Company for Diversity by DiversityInc and a Top Veteran-Friendly Company by U.S. Veterans Magazine. It has also been listed on FORTUNE® magazine's list of the World's Most Admired Companies for several consecutive years.

Centene Corp Careers

Join the dynamic team at Centene Corp, a leader in the healthcare industry, where your career growth and development are prioritized. At Centene Corp, we offer a range of job opportunities that allow you to make a significant impact on our community and beyond.

Explore a World of Opportunities

Discover the diverse career paths available at Centene Corp, from healthcare services to innovative program development. Our job opportunities span various professional fields, offering positions that cater to your unique skills and ambitions. Whether you're looking for an entry-level role or a senior leadership position, Centene Corp is committed to hiring top talent and fostering a culture of excellence.

Innovation and Leadership at Centene Corp

At Centene Corp, innovation and leadership go hand in hand. We empower our team members to lead with confidence and creativity, driving the company forward through strategic innovation and robust leadership. Our leadership programs are designed to cultivate your skills, helping you to thrive as a professional and make meaningful contributions to our company and the communities we serve.

Internships and Early Career Programs

Kickstart your career with Centene Corp through our internship and early career programs. These opportunities provide hands-on experience and a glimpse into the dynamic world of healthcare management. Internships at Centene Corp are a stepping stone to full-time employment, offering invaluable networking opportunities, mentorship, and the chance to develop your resume and interview skills in a real-world setting.

Commitment to Diversity and Inclusive Culture

Centene Corp is dedicated to maintaining a diverse and inclusive work environment. We believe that diversity fuels innovation and enhances our team's performance. Our diversity training ensures that all team members appreciate and leverage the broad range of experiences and perspectives that each individual brings to the company.

Benefits and Employee Growth

We value our employees' well-being and career aspirations. Centene Corp offers competitive benefits, including health insurance, retirement plans, and professional development programs. Our commitment to your growth is reflected in our continuous learning initiatives and performance management processes that help you achieve your career goals.

Join Our Team

Are you ready to advance your career at Centene Corp? Explore our current job openings and find the position that best matches your skills and interests. We are looking for passionate, curious, and solution-driven team players who are ready to make a difference.

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SEARCH CENTENE JOBS

Centene Corp is not just a company—it's a place where you can shape your future and impact the lives of millions. Join us in our mission to transform the health of the community, one person at a time.
Learn more about Centene Corp
Size
72,500 employees
Market Cap
$46.5 billion
Industry
Net Income
$1.8 billion
Founded
1984
5 Year Trend
+25.4%
Revenue
$111.1 billion
NASDAQ

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