Senior Compliance Oversight Specialist

Participate in the auditing, monitoring, and oversight of Centene's, its broker and distribution partners, subsidiaries, and/or its third parties /subcontractors' corporate ethics and compliance program, and ongoing oversight and analysis of regulatory compliance issues. Conduct audit, oversight, and monitoring activities to assess compliance with aspects of Centene's contractual and regulatory requirements. Responsible for collaborating with business owners, broker and distribution partners, and/or third parties/subcontractors to drive remediation and assist Centene and third parties/subcontractors to maintain integrity through audit, oversight and monitoring and in meeting government-sponsored health care program requirements.

Educate brokers on audit findings, program requirements and policies and procedures. Create and deliver corrective action plans, monitor probationary periods and disciplinary actions.

Key Details:
Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States.

Prepare formal written reports on audit, oversight and monitoring activity findings and recommendations.

Collaborate to direct compliance issues to appropriate channels for research and resolution.

Serve as a key contributor to Issue Management by reviewing and evaluating the status and effectiveness of corrective action plans, tracking identified issues through remediation and closure, and providing comprehensive follow up.

Communicate the importance of compliance and the Compliance Program, including promoting increased awareness of the Enterprise Ethics and Compliance Program; understanding of new and existing compliance issues and related policies and procedures; and importance of implementing and maintaining effective oversight and monitoring activities.

Support management in the development and maintenance of monitoring and auditing tools designed to evaluate internal, brokers and distribution partners and/or third party/subcontractor compliance with aspects of government-sponsored health care program requirements. May also include state Medicaid annual work plans, OIG/CMS initiatives across claims, credentialing, network management and customer service functions.

Educate, encourage, and assist those within the company and with the company's third parties/subcontractors to maintain integrity through oversight and monitoring and in meeting the requirements of Government-sponsored health care programs.

Assist in the assessment of new and amended government-sponsored health care program contracts and requirements.

Assist Health Plans, Subsidiaries, Shared Services, and Third Parties/Subcontractors in the identification and assessment of compliance risks.

Serve as a compliance advisor to business units and third parties with specialized focus, including but not limited to, claims / payments, credentialing, network management, financial solvency.

Performs other duties as assigned.

Complies with all policies and standards.

Bachelor's Degree in Healthcare, Audit, Business, or related field or equivalent experience required; or High School/GED and 5+ years of related experience required

CHC - Certified Healthcare Compliance preferred

Certified Internal Auditor (CIA) preferred

Pay Range: $70,100.00 - $ per year

At Centene, we connect people to the care they need to live healthier lives - and the work you do here makes that impact real every day. 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…