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Centene CorporationPosted 10/20/2026full-timeRemote • Texas • United StatesJuniorMid-Level💰 $56,200 - $101,000 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in conducting fraud, waste, and abuse investigations within healthcare, utilizing data analytics and investigative resources. Proficient in analyzing claims, medical records, and provider billing practices while ensuring compliance with federal and state regulations.
Highest-signal resume keywords
Fraud InvestigationsHealthcare ComplianceData AnalyticsClaims AuditsInvestigative Reporting
About the role
Key responsibilities & impact- Conduct fraud, waste, and abuse investigations using referrals, claims data, medical records, interviews, data analytics, and other investigative resources
- Analyze, document, and maintain investigative activities, findings, recommendations, and outcomes
- Review claims, medical records, provider billing practices, enrollment information, financial records, and other documentation
- Prepare investigative reports, case summaries, referrals, and supporting documentation
- Collaborate with internal business partners, compliance, legal, provider and payment integrity teams, and external agencies
- Support audits, overpayment identification and recovery efforts, regulatory responses, special projects, and program integrity initiatives
- Monitor emerging fraud schemes, billing irregularities, and healthcare program risks
- Support case progression through onsite audits, visits, drive-by activities, and member, provider, and witness interviews
- Perform other duties as assigned
- Comply with all policies and standards
Requirements
What you’ll need- Bachelor's Degree Business, Criminal Justice, Healthcare Administration, Public Health, or a related field; or equivalent experience required
- 2+ years Fraud, waste, and abuse investigations, healthcare investigations, claims audits, payment integrity, healthcare compliance, law enforcement investigations, or a related investigative field required
- Experience analyzing healthcare claims, medical records, billing and coding documentation, provider data, financial information, or related records preferred
- Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Examiner (CFE), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), or other related investigative, auditing, or compliance certification preferred
- Compliance with applicable federal and state regulations, contractual requirements, privacy standards, investigative protocols, and organizational policies and procedures
- 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- Health insurance
- 401K
- 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
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Fraud InvestigationsData AnalyticsClaims AuditsHealthcare InvestigationsBilling Documentation AnalysisFinancial Record ReviewProvider Data AnalysisInvestigative ReportingCase SummarizationOverpayment Identification
Soft Skills
CollaborationCommunicationAnalytical ThinkingAttention to DetailProblem Solving
Certifications & Qualifications
Accredited Healthcare Fraud Investigator (AHFI)Certified Fraud Examiner (CFE)Certified Professional Coder (CPC)Certified Professional Medical Auditor (CPMA)
Industry Keywords
Healthcare FraudWaste and AbusePayment IntegrityRegulatory ComplianceInvestigative ProtocolsHealthcare ClaimsBilling IrregularitiesProgram Integrity InitiativesFederal RegulationsState Regulations