Payment Integrity Systems Specialist II

Job not on LinkedIn

🔥 0 minutes ago

🐊 Florida, Illinois, +2 more states – Remote

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

💵 $63.6k - $114.6k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 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

• Conduct moderately complex analysis of Payment Integrity platform outputs, claims system data, edit/rule behavior, financial/reporting outputs, and workflow performance • Identify exceptions, trends, and operational impacts • Manage ServiceNow or similar incidents, defects, enhancement requests, and intake items • Document requirements, track status, coordinate follow-up, and escalate blockers • Coordinate UAT, regression testing, validation, and release-readiness activities for system changes • Validate defects and communicate operational impacts • Develop and maintain dashboards, trackers, recurring reports, and workstream visibility tools • Support platform enhancements, defects, metrics, savings opportunities, and operational improvement initiatives • Gather and analyze data using Excel, SQL, Power BI, financial reporting tools, or approved reporting platforms • Partner with Operations, Technology, Finance, governance/delivery, and business stakeholders • Clarify requirements, document decisions, and support transformation workstreams • Improve data quality, documentation, process consistency, and operational readiness • Provide informal guidance or onboarding support to less-experienced team members • Perform other duties as assigned and comply with policies and standards

🎯 Requirements

• Bachelor's degree in healthcare, business, finance, accounting, information systems, data analytics, or a related field, or equivalent experience • 2+ years of relevant experience in Payment Integrity systems, managed care claims systems, data analytics, financial reporting, business analysis, platform support, quality assurance, UAT, or related technical healthcare function • Working knowledge of managed care claims, Payment Integrity concepts, system workflows, reporting, and operational controls • Experience with ticketing, UAT/testing documentation, dashboards, workflow tracking, data validation, and cross-functional issue resolution • Working proficiency with Excel and developing proficiency with SQL, Power BI, financial reporting tools, or similar data/reporting platforms • Platform Support & Governance • Data Validation & Reporting • Defect & Enhancement Intake • UAT / Regression Testing • Release Readiness • Financial Systems / Reporting • Dashboard / KPI Development • Configuration & Edit Support • Related Payment Integrity systems and technology support functions • Experience with Payment Integrity platforms, claims systems, ServiceNow, Power BI, edit/rule configuration, workflow automation, or platform modernization workstreams preferred • Working knowledge of financial systems, accounting principles, and operational financial reporting preferred • Credentials or training in Power BI, SQL, business analysis, Lean Six Sigma, healthcare data analytics, project coordination, or coding/claims concepts preferred • LPN, RN, CPC, CPC-H, CPC-P, CCS, CCS-P, RHIT, RHIA, or CPMA; RHIT, CCS, CIC, CCDS 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