Manager, SIU Intelligence – Innovation

🕒 il y a 1 mois

🐊 Florida, New York, +2 états de plus – Distant

🐊 Florida – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏰 Missouri – Remote

💵 $87 700 - $157 800 / an

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

👔 Manager

👻 Score fantôme 16%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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Centene Corporation

Site WebLinkedInTous les Emplois

10 000+ employés

Fondée en 1984

🛡️ Assurance

💼 Conseil

🏥 Santé

Insurance • Consulting • Healthcare

La société Centene Corporation est un leader dans la fourniture de services de santé subventionnés par le gouvernement, spécialisée dans la délivrance de solutions de santé abordables et de haute qualité. Depuis plus de 40 ans, Centene s’est concentrée sur la transformation de la santé des communautés en élargissant l'accès aux services de Medicaid, Medicare, et au marché de l'assurance santé, tout en servant les communautés militaires à travers le programme TRICARE. En tant que plus grande organisation de gestion des soins Medicaid et un acteur clé du marché, Centene met l'accent sur une prestation de soins de santé localisée combinée à des partenariats solides avec des organisations à but non lucratif pour répondre aux besoins uniques de ses membres. Centene s’engage également pour le développement durable et la responsabilité sociale des entreprises, en privilégiant la gestion environnementale et la gouvernance éthique afin d'améliorer le bien-être des communautés qu’elle dessert.

Description

• Lead the strategic direction, development, and optimization of SIU capabilities supporting detection, prevention, and investigation of fraud, waste, and abuse (FWA) • Drive utilization of internal and external data assets, advanced analytic tools, predictive monitoring methodologies, and emerging technologies • Partner with SIU leadership, Medical Economics, Pharmacy, Compliance, and enterprise stakeholders to develop detection strategies and data-driven insights • Lead analytics personnel, enterprise data initiatives, modernization efforts, vendor relationships, and industry partnerships • Support planning, development, and execution of proactive anti-fraud detection and analytics programs • Manage, mentor, and develop team members, including hiring, performance management, training, coaching, and resource allocation • Optimize analytics resources including HCFS PostShield, AI Shield, Pharmacy Shield, and other data assets • Develop and implement analytic methodologies, dashboards, reporting solutions, and predictive monitoring capabilities • Evaluate emerging fraud schemes, industry risks, and analytical opportunities • Transform large, complex datasets into actionable intelligence for lead maturation, investigations, and fraud prevention • Support healthcare fraud analytics involving provider, member, pharmacy, and premium-related fraud detection • Facilitate data quality improvement, data remediation, and cross-functional enterprise and external data initiatives • Develop and maintain an SIU analytics roadmap with performance objectives, savings targets, value realization metrics, and operational outcomes • Oversee analytics-related vendor relationships and monitor performance • Represent SIU in data governance, analytics, innovation, and strategic planning forums • Communicate analytical findings, trends, risks, and recommendations to senior leadership and stakeholders • Lead cross-functional teams in fraud investigations and intelligence efforts • Monitor emerging fraud schemes and technological advancements • Collaborate with regulatory bodies and industry stakeholders • Manage training program development and implementation • Provide strategic recommendations to leadership and perform other duties as assigned

🎯 Exigences

• 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 • 5+ years of experience in healthcare analytics, fraud detection, SIU operations, program integrity, payment integrity, healthcare investigations, or related analytical functions • 2+ years conducting healthcare fraud investigations and knowledge of fraud, waste, and abuse trends and schemes • Experience leading, mentoring, coordinating, or managing analytical resources, projects, or teams • Experience developing and implementing advanced analytics, predictive monitoring, reporting, data visualization, and fraud detection methodologies using large and complex healthcare datasets • Experience collaborating with operational, compliance, investigative, and analytics stakeholders • Experience leading healthcare analytics, SIU, Program Integrity, Payment Integrity, Compliance, or FWA initiatives preferred • Experience with advanced analytics, predictive modeling, artificial intelligence, machine learning, fraud detection technologies, and external data resources preferred • Master's Degree preferred • Juris Doctor (JD) preferred • CFE, AHFI, CHC, PMP, SAS, CPC, or related certifications preferred • Compliance with all policies and standards

🏖️ Avantages

• Competitive pay • Health insurance • 401K • Stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Potential additional forms of incentives