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Centene Corporation
Centene Corporation
ConsultingHealthcareInsurance
Centene Corporation is a healthcare and insurance company focused on government-sponsored coverage and community health. Its services include Medicaid, Medicare, Health Insurance Marketplace plans, and TRICARE support for military communities. Centene combines localized care delivery with partnerships with nonprofit organizations to address the needs of the members it serves. The company also incorporates environmental responsibility and ethical governance into its approach to operating and supporting communities.
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Program Manager III, SIU Intelligence and Innovation - Remote

Lead Centene’s healthcare fraud intelligence and anti-fraud innovation programs. Apply complex healthcare data, analytics, and predictive monitoring to support investigations and fraud prevention in New York.

USUnited StatesNYNew York
$87,700 – $157,800 / year
RemoteFull-timeMiddleSeniorEnglish RequiredProgram Manager
PMP

Description

  • Guide the strategy, development, and delivery of SIU anti-fraud detection programs, analytics initiatives, tools, and priorities.
  • Convert complex, high-volume data into defensible insights that support investigative leads, case development, fraud prevention, and informed decisions.
  • Use HCFS PostShield, AI Shield, Pharmacy Shield, and other internal and external data sources to detect emerging risks and shape detection strategies.
  • Work with SIU leaders and enterprise partners to develop analytical methods, predictive monitoring solutions, dashboards, performance measures, and reporting.
  • Coordinate with teams across SIU, Claims, Configuration, IT, Clinical, Compliance, Market Operations, and external organizations.
  • Track developing fraud schemes, industry patterns, regulatory changes, and opportunities to improve analytical capabilities.
  • Present analytical results, fraud trends, program outcomes, financial effects, risks, and strategic recommendations to senior leaders and stakeholders.
  • Keep audit-ready records covering program roadmaps, governance materials, risk and decision logs, methodologies, claim-volume analyses, performance measures, and financial reporting.
  • Complete additional responsibilities as assigned.
  • Follow all applicable policies and operating standards.

Requirements

  • Bachelor’s degree in business administration, healthcare administration, or a related discipline, or four years of equivalent experience.
  • At least five years of experience in program, project, or product management.
  • Experience in healthcare fraud, analytics, investigations, project management, data science, or a related healthcare setting is preferred.
  • Preferred credentials include CFE, AHFI, CHC, PMP, SAS, or CPC.
  • Meet enterprise governance standards, regulatory obligations, and applicable policies and operating requirements.
  • Applicants with arrest or conviction records will be considered under the LA County Ordinance and California Fair Chance Act.

Benefits

  • Competitive compensation.
  • Health insurance coverage.
  • 401(k) plan.
  • Employee stock purchase plans.
  • Tuition reimbursement.
  • Paid time off and holidays.
  • Flexible remote, hybrid, field, or office work arrangements.
  • Additional incentives may form part of total compensation.
  • Equal opportunity employment with a commitment to diversity.

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