Manager, Payment Integrity - Intake & Demand

About the role

Centene is seeking a Manager to lead its Payment Integrity – Intake & Demand function. You will shape fraud, waste, and abuse (FWA) strategies that protect the health of millions of members while ensuring compliance with state and federal requirements.

Key responsibilities

• Develop, implement and manage strategic FWA activities, maintaining compliance with state and federal regulations.
• Monitor business processes and systems to ensure billing and claims payment integrity.
• Lead analyst teams, overseeing investigations of fraud, waste, and abuse referrals.
• Create customized fraud plans to meet contractual and federal obligations.
• Produce educational materials to identify and validate waste activities.
• Respond to RFPs and implement new policies as required by contracts.
• Attend state and federal meetings and present the FWA program during readiness reviews.
• Review post‑payment cases to secure refunds and compile monthly/quarterly savings reports.
• Perform additional duties as assigned and ensure adherence to all policies and standards.

Required profile

• Bachelor’s degree in Business, Healthcare, Criminal Justice or a related field, or equivalent experience.
• At least 4 years of experience in medical claim investigation, compliance, or fraud and abuse.
• Thorough knowledge of medical terminology.
• Prior experience in a managed‑care environment and supervisory roles preferred.
• Medical records or coding license preferred.

Required skills

What we offer

• Competitive salary range of $87,700 – $157,800 per year.
• Comprehensive benefits including health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off and holidays.
• Flexible work arrangements (remote, hybrid, field, or office).
• Commitment to diversity, equity and inclusion.