You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

　　Position Purpose: Investigate allegations of potential healthcare fraud and abuse activity. Assist in planning, organizing, and executing claims investigations or audits that identify, evaluate and measure potential healthcare fraud and abuse.

　　Conduct investigations of potential waste, abuse, and fraud

　　Document activity on each case and refer issues to the appropriate party

　　Perform data mining and analysis to detect aberrancies and outliers in claims

　　Develop new queries and reports to detect potential waste, abuse, and fraud

　　Provide case updates on progress of investigations and coordinate with Health Plans on recommendations and further actions and/or resolutions

　　Assist with complex allegations of healthcare fraud

　　Prepare summary and/or detailed reports on investigative findings for referral to Federal and State agencies

　　Complete various special projects and audits

　　Education/Experience: Bachelor’s Degree in Business, Criminal Justice, Healthcare, related field or equivalent experience. 1+ years of medical claim investigation, medical claim audit, medical claim analysis, or fraud investigation experience. Knowledge of Microsoft Applications, medical coding and terminology preferred.

　　Please note: this is a remote position with high preference on candidates located within the NY area.

　　Pay Range: $52,900.00 - $95,200.00 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. Total compensation may also include additional forms of incentives.

　　Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.