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About the Role
This role is critical to advancing SIU’s Intelligence & Innovation strategy through the design, development, and execution of proactive fraud detection, analytics, and investigative intelligence programs. The position serves as a key driver in identifying emerging fraud risks, transforming complex data into actionable intelligence, and delivering innovative solutions that enhance SIU’s effectiveness, operational efficiency, and enterprise value.
Responsibilities
- Supports the strategic planning, development, and execution of SIU proactive anti-fraud detection, tools and analytics programs, initiatives, and priorities.
- Transforms large and complex data sets into actionable analytical insights for investigative lead generation, case development, and fraud prevention.
- Leverages advanced analytical resources to identify emerging risks and develop innovative detection strategies.
- Partners with SIU leadership and stakeholders to design and implement advanced analytical methodologies and predictive monitoring solutions.
- Collaborates across departments and with external partners to communicate program objectives and drive outcomes.
- Researches and evaluates emerging fraud schemes, industry trends, and analytical opportunities.
- Communicates analytical findings, fraud trends, and strategic recommendations to senior leadership.
- Maintains comprehensive, audit-ready documentation for programs and analyses.
- Performs other duties as assigned.
- Complies with all policies and standards.
Requirements
- Bachelor's Degree in Business Administration, Healthcare Administration, or related field, or four (4) years of equivalent experience required.
- 5+ years of program, project, or product management experience required.
- Experience related to healthcare fraud, analytics, investigations, project management, data science, or other related healthcare environments preferred.
- Preferred credentials: CFE, AHFI, CHC, PMP, SAS, CPC.
Work Type
- remote
- hybrid
- field
- office
Experience Level
- 5+ years of program, project, or product management experience
Education Level
- Bachelor's Degree in Business Administration, Healthcare Administration, or related field
- Equivalent experience
Salary/Compensations
- $87,700.00 - $157,800.00 per year
Benefits
- Competitive pay
- Health insurance
- 401K and stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work
About the Company
- At Centene, we connect people to the care they need to live healthier lives.
- You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective.
- It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
Equal Opportunity
- 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.
- Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.