Program Manager III – SIU Intelligence, Innovation

Centene Corporation

. Support strategic planning, development, and execution of SIU proactive anti-fraud detection, tools, analytics programs, initiatives, and priorities .

Posted 10/2/2026full-timeRemote • New York • United StatesMid-LevelSenior💰 $87,700 - $157,800 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare fraud detection and analytics, leveraging data-driven insights to inform strategic decision-making and compliance with regulatory standards. Proficient in program management and collaboration across diverse teams to implement effective fraud prevention initiatives.

Highest-signal resume keywords

Healthcare Fraud DetectionData AnalyticsProgram ManagementPredictive Monitoring SolutionsCompliance Standards

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data ScienceAnalytical MethodologiesFraud PreventionPerformance MetricsCase DevelopmentInvestigative Lead GenerationRisk AssessmentFinancial Impact ReportingDashboard DevelopmentDocumentation Maintenance

Soft Skills

CommunicationCollaborationStrategic PlanningProblem-SolvingStakeholder Engagement

Tools & Technologies

HCFS PostShieldAI ShieldPharmacy Shield

Certifications & Qualifications

CFEAHFICHCPMPSASCPC

Industry Keywords

Healthcare AdministrationRegulatory ComplianceFraud SchemesGovernance StandardsMarket Operations

Tech Stack

Tools & technologies

PMP

About the role

Key responsibilities & impact

Support strategic planning, development, and execution of SIU proactive anti-fraud detection, tools, analytics programs, initiatives, and priorities
Transform large and complex data sets into defensible, actionable analytical insights for investigative lead generation, case development, fraud prevention, and data-driven decision-making
Leverage HCFS PostShield, AI Shield, Pharmacy Shield, and other internal and external data assets to identify emerging risks and develop detection strategies
Partner with SIU leadership and enterprise stakeholders to design and implement analytical methodologies, predictive monitoring solutions, dashboards, performance metrics, and reporting capabilities
Collaborate across SIU, Claims, Configuration, IT, Clinical, Compliance, Market Operations, and external partners
Research, evaluate, and monitor emerging fraud schemes, industry trends, regulatory developments, and analytical opportunities
Communicate analytical findings, fraud trends, program performance, financial impact, risks, and strategic recommendations to senior leadership and stakeholders
Maintain audit-ready documentation, including program roadmaps, governance artifacts, risk and decision logs, methodology documentation, claim volume analyses, performance metrics, and financial impact reporting
Perform other duties as assigned
Comply with all policies and standards

Requirements

What you’ll need

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
Compliance with enterprise governance standards, regulatory requirements, policies, and standards
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Benefits

Comp & perks

Competitive pay
Health insurance
401K plan
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