Centene Corp

Senior SIU Investigator

Centene Corp • $70K — $126K *
US-Anywhere
+ 7 other locationsRemote
Healthcare
Less than 5 years of experience
Today
Be an Early Applicant
Job Overview by Ladders

Qualifications

  • Bachelor's Degree in Business, Criminal Justice, Healthcare Administration, Public Health, or related field; or equivalent experience required.
  • Master's Degree preferred.
  • 4+ years of experience conducting fraud, waste, and abuse investigations, healthcare fraud investigations, and related work required.
  • Experience leading complex investigations coordinating with multiple data sources and stakeholders required.
  • Proficient in preparing investigative reports, referrals, and documentation for various stakeholders required.
  • Experience with federal and state healthcare regulations, including Medicaid and Medicare, preferred.

Responsibilities

  • Lead complex investigations into fraud, waste, and abuse involving various entities.
  • Analyze claims, medical records, and financial information to identify fraud and compliance issues.
  • Develop and manage investigative strategies in accordance with laws and regulations.
  • Prepare detailed reports and recommendations for leadership and regulatory bodies.
  • Serve as a subject matter expert, guiding investigative staff on techniques and standards.
  • Collaborate with compliance, legal, and law enforcement to support investigative efforts.
  • Identify emerging fraud schemes and recommend improvements in investigative processes.

Benefits

  • Competitive pay and comprehensive health insurance.
  • 401K and stock purchase plans.
  • Tuition reimbursement for further education.
  • Paid time off plus holidays.
  • Flexible work schedule options, including remote and hybrid arrangements.
Full Job Description
Position Purpose: Independently leads complex fraud, waste, and abuse (FWA) investigations involving providers, members, pharmacies, vendors, and other entities. Utilizes advanced investigative techniques, data analysis, and case development strategies to identify potential misconduct, support corrective actions and recoveries, and resolve high-risk matters. Serves as a subject matter resource for investigative staff and prepares comprehensive findings, referrals, and recommendations for leadership, regulatory agencies, and law enforcement entities, as appropriate.

  • Independently leads complex fraud, waste, and abuse (FWA) investigations involving providers, members, pharmacies, vendors, and other entities utilizing referrals, claims data, medical records, interviews, analytics, and other investigative resources.
  • Analyzes and interprets complex claims, billing patterns, medical records, provider documentation, financial information, and other evidence to identify potential fraud, waste, abuse, overpayments, and compliance concerns.
  • Develops investigative strategies, establish case direction, and manage investigations through resolution in accordance with applicable laws, regulations, contractual requirements, and organizational policies and procedures.
  • Prepares comprehensive investigative reports, referrals, case summaries, and supporting documentation for leadership, regulatory agencies, law enforcement entities, and other authorized stakeholders.
  • Serves as a subject matter resource to investigative staff by providing guidance on investigative techniques, case development, documentation standards, evidentiary requirements, and regulatory considerations.
  • Collaborates with internal and external stakeholders, including Compliance, Legal, Payment Integrity, Provider Relations, government agencies, and law enforcement partners, to support investigative activities, corrective actions, recoveries, and case resolution.
  • Identifies emerging fraud schemes, billing irregularities, control gaps, and program integrity risks, and recommend enhancements to investigative processes, monitoring activities, and analytical approaches.
  • Supports audits, overpayment identification and recovery efforts, regulatory responses, special projects, enterprise initiatives, and other complex investigative matters.
  • Ensures investigative activities meet established quality, timeliness, documentation, service level, and regulatory requirements.
  • Assists in the development and delivery of training, knowledge sharing, and continuous improvement initiatives to support investigative effectiveness and program integrity objectives.
  • Supports investigative case progression through onsite audits, visits, drive-by and additional investigative activities such as a member, provider, witness interviews, etc.
  • Performs other duties as assigned.
  • Complies with all policies and standards.


Education/Experience:

  • Bachelor's Degree Business, Criminal Justice, Healthcare Administration, Public Health, or a related field; or equivalent experience required.
  • Master's Degree preferred
  • 4+ years Conducting fraud, waste, and abuse investigations, healthcare fraud investigations, claims audits, payment integrity reviews, healthcare compliance investigations, law enforcement investigations, or related investigative work required.
  • Experience leading complex investigations involving multiple data sources, extensive analysis, and coordination with internal and external stakeholders required.
  • Experience preparing investigative reports, referrals, presentations, and supporting documentation for leadership, regulatory agencies, and law enforcement entities required.
  • Experience interpreting and applying federal and state healthcare regulations, including Medicaid, Medicare, and other government-sponsored healthcare programs preferred.
  • Additional qualifications may be required to satisfy applicable federal, state, regulatory, contractual, or program-specific requirements.


Licenses/Certifications:
  • Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or other related investigative, auditing, or compliance certification preferred.


Pay Range: $70,100.00 - $126,200.00 per year

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.

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.

Stay Connected with Centene Careers

Keep up to date with the latest career tips, insider perspectives, and industry-leading insights—all from the people who work at Centene Corp. Personalize your subscription to receive job alerts, latest news, and insider tips tailored to your preferences. Discover the exciting and rewarding opportunities that await you at Centene Corp.

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
Healthcare
Net Income
$1.8 billion
Founded
1984
5 Year Trend
+25.4%
Revenue
$111.1 billion
NASDAQ
CNC
* Ladders Estimates

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