Lead Payment Integrity Systems Specialist

Job not on LinkedIn

🔥 1 hour ago

🐊 Florida, Illinois, +2 more states – Remote

🐊 Florida – Remote 🌽 Illinois – Remote 🏰 Missouri – Remote 🤠 Texas – Remote

💵 $87k - $161.3k / year

⏰ Full Time

🟠 Senior

👻 Ghost score 0%

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Centene Corporation

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1984

🛡️ Insurance

💼 Consulting

🏥 Healthcare

Insurance • Consulting • Healthcare

Centene Corporation is a leading provider of government-sponsored healthcare services, specializing in delivering affordable and high-quality healthcare solutions. For over 40 years, Centene has focused on transforming the health of communities by expanding access to Medicaid, Medicare, and Health Insurance Marketplace services, as well as serving military communities through the TRICARE program. As the largest Medicaid managed care organization and a key participant in the Marketplace, Centene emphasizes localized healthcare delivery combined with strong partnerships with nonprofit organizations to meet the unique needs of its members. Centene is also committed to corporate sustainability and social responsibility, prioritizing environmental stewardship and ethical governance to enhance the well-being of the communities it serves.

📋 Description

• Serve as the senior individual contributor and enterprise-level subject-matter expert for Payment Integrity systems, platform governance, analytics, financial reporting, and operational visibility • Lead enterprise-level analysis of Payment Integrity system, claims, workflow, financial, and reporting data • 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 • Align Operations, Technology, Finance, governance, and leadership stakeholders on scope, impact, risk, decisions, and readiness • Own operating routines governing incidents, defects, enhancements, releases, automation opportunities, and modernization workstreams • Translate complex cross-platform results into executive-ready summaries, strategic recommendations, implementation plans, and measurable success criteria • Advise leadership on platform governance, financial reporting, data quality controls, process standardization, and long-term system capability needs • Lead 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 • Perform other duties as assigned • Comply with all policies and standards

🎯 Requirements

• Bachelor's Degree in healthcare, business, finance, accounting, information systems, data analytics, or a related field, or equivalent experience required • 5+ 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 • Experience setting platform governance, operational visibility standards, dashboard/reporting strategy, release-readiness routines, and cross-functional technology operating models preferred • Advanced credentials in data analytics, business analysis, healthcare data, project/program management, Lean Six Sigma, finance/accounting, SQL, or related systems disciplines preferred • LPN, RN, CPC, CPC-H, CPC-P, CCS, CCS-P, RHIT, RHIA, CPMA, CIC, or CCDS certifications preferred

🏖️ Benefits

• Competitive pay • Health insurance • 401K and stock purchase plans • Tuition reimbursement • Paid time off plus holidays • Flexible approach to work with remote, hybrid, field or office work schedules • Additional forms of incentives may be included in total compensation • Equal opportunity employer committed to diversity