Centene Corp

Sr. Manager Payment Integrity - Health Plan Concierge

Centene Corp • $107K — $199K *
US-Anywhere
+ 3 other locationsRemote
Healthcare
5 - 7 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Bachelor’s degree in Healthcare Administration, Business, Public Health, Health Information Management, or related field; Master's preferred.
  • 6+ years experience in Payment Integrity or managed care operations.
  • 4+ years of leadership experience with direct reports.
  • 3+ years experience with Payment Integrity functions like pre-pay edits or audits.
  • Strong understanding of payment integrity concepts and regulatory requirements.
  • Proven ability to analyze data for operational improvements and trends.
  • Experience leading provider-facing communications and issue resolution.

Responsibilities

  • Provide strategic leadership for Payment Integrity within a designated business segment.
  • Implement strategies to reduce improper payments and enhance claims accuracy.
  • Maintain governance processes and performance measures ensuring operational integrity.
  • Collaborate with various departments to address and resolve systemic issues.
  • Lead analytics activities to identify provider pain points and operational risks.
  • Direct provider education efforts ensuring clear communication of policies and processes.
  • Oversee resolution of complex provider issues and case management.

Benefits

  • Competitive pay and health insurance.
  • 401K and stock purchase plans.
  • Tuition reimbursement for continuing education.
  • Flexible work arrangements including remote, hybrid, and office schedules.
  • Paid time off plus holidays.
Full Job Description

Position Purpose:
Provides strategic leadership across the Health Plan Concierge vertical, overseeing market engagement, provider alignment, escalation management, and cross-functional coordination. Leads teams that address provider and market needs, resolves issues effectively, and ensures market insights inform Payment Integrity priorities. Directs forums and taskforces that translate experience signals into actionable priorities, supporting claims accuracy, reduced improper payments, and improved financial performance. Partners with business, clinical, legal, compliance, technology, and network leaders to deliver effective provider education, strengthen governance, and drive adoption of initiatives that support sustainable medical cost savings and enterprise operational excellence.

  • Provides operational and strategic leadership for Payment Integrity activities within an assigned line of business, supporting market-facing efforts such as provider engagement, issue resolution, escalation management, communications and cross-functional coordination.
  • Executes program strategies that reduce improper payments, enhance claims accuracy, and support financial and operational objectives for the assigned business segment, ensuring alignment with broader enterprise PI goals.
  • Implements and maintains governance processes, controls, documentation standards, and performance measures that uphold accuracy, compliance, and operational integrity within the line of business.
  • Collaborates with partners across Claims, Clinical, Finance, Compliance, Provider Relations, Network, Legal, IT, and Health Plan teams to address systemic issues, resolve escalations, improve workflows, and enhance provider and member experience.
  • Leads insight-generation and analytics activities for the assigned line of business identifying provider pain points, operational risks, emerging trends, and opportunities to improve payment accuracy and prevent issue.
  • Directs provider education and communication efforts by delivering clear, consistent messaging tied to PI edits, audits, policies, and process changes and supporting successful adoption across internal and external stakeholders.
  • Oversees activities related to resolving complex provider issues, including coordinating supporting documentation, clarifying program requirements, and collaborating with internal partners to ensure timely and accurate case management.
  • Ensures compliance with CMS, Medicaid, Medicare, state regulatory requirements, coding and documentation standards, and all applicable policies, applying enterprise guidance to the unique needs of the assigned line of business.
  • Presents program performance, provider issue themes, savings outcomes, and risk mitigation strategies to inform prioritization, governance decisions and organizational planning.
  • Performs other duties as assigned.
  • Complies with all policies and standards.


Education/Experience:
Bachelor’s degree in Healthcare Administration, Business, Public Health, Health Information Management, or related field or equivalent work experience required. Master’s degree preferred.

  • 6+ years of experience in Payment Integrity, claims operations, reimbursement methodologies, or managed care operations within a complex health plan, multi-line payer.
  • 4+ years of experience of leadership experience with direct reports
  • 3+ Experience with PI functions such as pre-pay edits, post-pay audits, analytics, or fraud/waste/abuse functions programs
  • 2+ years of managing escalated issues with Senior Leaders
  • Experience working with cross-functionally with Network, Claims, Clinical, Legal, Compliance, IT, Finance, and Health Plan leadership to resolve provider or market challenges.
  • Experience leading provider-facing work, including communications, education, disputes, or external stakeholder engagement.
  • Strong understanding of payment integrity concepts, reimbursement methodologies, provider workflows, and regulatory requirements relevant to the applicable line of business.
  • Ability to use analytics and insights to identify trends, diagnose root cause, and drive operational and improvement.
  • Strong communication and relationship management skills with the ability to translate complex PI programs into clear guidance for internal and external audiences.
  • Ability to influence across a matrixed environment and effectively communicate risk, compliance considerations, and operational impacts to expectations to leadership.
  • Experience with Medicaid and/or Medicare managed care requirements and regulatory expectations, preferred.

Pay Range: $107,700.00 - $199,300.00 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.

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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
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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