Senior Compliance Oversight Specialist

🔥 0 minutes ago

🏰 Missouri – Remote

🏰 Missouri – Remote

💵 $70.1k - $126.2k / year

⏰ Full Time

🟠 Senior

🚔 Compliance

👻 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

• Participate in auditing, monitoring, and oversight of Centene's ethics and compliance program and those of partners, subsidiaries, and third parties/subcontractors • Conduct audit, oversight, and monitoring activities assessing compliance with contractual and regulatory requirements • Collaborate with stakeholders to drive remediation and maintain compliance with government-sponsored health care program requirements • Educate brokers on audit findings, program requirements, policies, and procedures • Create and deliver corrective action plans; monitor probationary periods and disciplinary actions • Prepare formal written reports on audit, oversight, and monitoring findings and recommendations • Direct compliance issues to appropriate channels for research and resolution • Review corrective action plan status and effectiveness, track issues through remediation and closure, and provide follow-up • Promote awareness of the Enterprise Ethics and Compliance Program and related policies and procedures • Support development and maintenance of monitoring and auditing tools • Support state Medicaid annual work plans and OIG/CMS initiatives across claims, credentialing, network management, and customer service • Assist with assessing new and amended government-sponsored health care program contracts and requirements • Assist Health Plans, Subsidiaries, Shared Services, and Third Parties/Subcontractors in identifying and assessing compliance risks • Serve as a compliance advisor to business units and third parties, including claims/payments, credentialing, network management, and financial solvency • Perform other duties as assigned and comply with all policies and standards

🎯 Requirements

• Bachelor's Degree in Healthcare, Audit, Business, or related field or equivalent experience required; or High School/GED and 5+ years of related experience required • CHC - Certified Healthcare Compliance preferred • Certified Internal Auditor (CIA) preferred • Experience in auditing, monitoring, and oversight of corporate ethics and compliance programs • Knowledge of contractual and regulatory requirements and government-sponsored health care program requirements • Ability to collaborate with business owners, broker and distribution partners, subsidiaries, and third parties/subcontractors • Ability to develop and monitor corrective action plans • Ability to assess compliance risks and regulatory compliance issues

🏖️ Benefits

• Competitive pay • Health insurance • 401K plan • 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