Lead Payment Integrity Systems Specialist

Centene Corporation

. Serve as the senior individual contributor and enterprise-level subject-matter expert for Payment Integrity systems, platform governance, analytics, financial reporting, and operational visibility .

Posted 10/2/2026full-timeRemote • United StatesSenior💰 $87,000 - $161,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Payment Integrity systems, financial reporting, and data governance, with a strong ability to lead cross-functional teams and communicate strategic insights to senior leadership. Proficient in SQL and analytics tools, with a focus on operational visibility and continuous improvement methodologies.

Highest-signal resume keywords

Payment Integrity Systems ExpertiseFinancial ReportingData Validation & ReportingUAT / Regression TestingPlatform Governance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

SQLFinancial ReportingData AnalyticsDashboard DevelopmentUAT / Regression TestingData ValidationOperational WorkflowsClaims Data AnalysisReporting ToolsProcess Standardization

Soft Skills

LeadershipCommunicationInfluencing Without AuthorityCoachingTechnical Direction

Tools & Technologies

Power BIServiceNowExcelReporting ToolsWorkflow Platforms

Certifications & Qualifications

LPNRNCPCCPC-HCPC-PCCSCCS-PRHITRHIACPMA

Industry Keywords

Healthcare AnalyticsManaged Care ClaimsOperational VisibilityCross-Functional TransformationFinancial SystemsData GovernancePlatform Change ManagementContinuous ImprovementExecutive-Level Data StorytellingLean Six Sigma

Tech Stack

Tools & technologies

ServiceNowSQL

About the role

Key responsibilities & impact

Serve as the senior individual contributor and enterprise-level subject-matter expert for Payment Integrity systems, platform governance, analytics, financial reporting, and operational visibility
Lead enterprise-level analysis of Payment Integrity system, claims, workflow, financial, and reporting data
Identify strategic risks, prioritization decisions, savings opportunities, and operational improvement recommendations
Set standards for technical review, data validation, dashboarding, reporting routines, ServiceNow intake, defect/enhancement prioritization, UAT/release readiness, post-release issue tracking, and operational visibility
Serve as the senior business-technology liaison for platform change management
Align Operations, Technology, Finance, governance, and leadership stakeholders on scope, impact, risk, decisions, and readiness
Own operating routines governing incidents, defects, enhancements, releases, automation opportunities, and modernization workstreams
Translate complex cross-platform results into executive-ready summaries, strategic recommendations, implementation plans, and measurable success criteria
Advise leadership on platform governance, financial reporting, data quality controls, process standardization, and long-term system capability needs
Lead continuous improvement of methodologies, standards, and job-family consistency across Payment Integrity system support and analytics functions
Provide technical leadership, coaching, peer review, and escalation support to PI Systems Specialist I, II, and Senior PI Systems Specialist team members
Perform other duties as assigned
Comply with all policies and standards

Requirements

What you’ll need

Bachelor's Degree in healthcare, business, finance, accounting, information systems, data analytics, or a related field, or equivalent experience required
5+ years of relevant experience in Payment Integrity systems, managed care claims systems, platform governance, financial reporting, healthcare analytics, business analysis, UAT/release readiness, or related technical healthcare function required
Specialized depth and/or breadth of expertise in Payment Integrity systems, claims data, operational workflows, data governance, financial reporting, system dependencies, and cross-functional transformation required
Advanced proficiency with SQL, reporting/analytics tools such as Power BI, financial reporting tools, Excel, ServiceNow or similar ticketing/workflow platforms, and executive-level data storytelling required
Demonstrated ability to lead technical direction, resolve precedent-setting issues, influence without formal authority, and communicate with senior leaders required
Platform Support & Governance required
Data Validation & Reporting required
UAT / Regression Testing required
Defect & Enhancement Intake required
Release Readiness required
Financial Systems / Reporting required
Dashboard / KPI Development required
Configuration & Edit Support required
Related Payment Integrity systems and technology support functions required
Advanced knowledge of financial systems and accounting principles preferred
Experience setting platform governance, operational visibility standards, dashboard/reporting strategy, release-readiness routines, and cross-functional technology operating models preferred
Advanced credentials in data analytics, business analysis, healthcare data, project/program management, Lean Six Sigma, finance/accounting, SQL, or related systems disciplines preferred
LPN, RN, CPC, CPC-H, CPC-P, CCS, CCS-P, RHIT, RHIA, CPMA, CIC, or CCDS certifications preferred

Benefits

Comp & perks

Competitive pay
Health insurance
401K and stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation
Equal opportunity employer committed to diversity