Senior Pharmacy SIU Investigator

About the role

Centene is seeking a Senior Pharmacy SIU Investigator to lead complex fraud, waste, and abuse investigations across providers, members, pharmacies, and vendors. The role utilizes advanced investigative techniques and data analysis to protect the integrity of our health plans serving 28 million members.

Key responsibilities

• Independently manage high‑risk investigations using claims data, medical records, interviews, and analytics.
• Analyze billing patterns, provider documentation, and financial information to uncover potential fraud, waste, abuse, and overpayments.
• Develop investigative strategies, direct case progression, and ensure resolution in line with laws, regulations, and company policies.
• Prepare comprehensive reports, referrals, and recommendations for leadership, regulatory agencies, and law‑enforcement partners.
• Serve as a subject‑matter resource, guiding investigative staff on techniques, documentation standards, and evidentiary requirements.
• Collaborate with Compliance, Legal, Payment Integrity, Provider Relations, and external agencies to support corrective actions and recoveries.
• Identify emerging fraud schemes and recommend enhancements to monitoring and analytical processes.

Required profile

• Extensive experience conducting complex fraud, waste, and abuse investigations in the healthcare or pharmacy sector.
• Strong knowledge of applicable laws, regulations, and contractual requirements.
• Proven ability to develop investigative strategies and manage cases to successful resolution.
• Excellent written communication skills for preparing detailed investigative reports.

Required skills

What we offer

• Competitive benefits package.
• Flexible workplace arrangements.
• Opportunity to impact the health of millions of members.