Compliance Corrections Specialist

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

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

Position Purpose: Participates in the oversight of Centene's and/or its third parties/subcontractor's corporate ethics and compliance program, and ongoing oversight and analysis of external and internal corrective actions. Responsibilities include conducting focused reviews and audit, oversight, and monitoring of activities to assess compliance with Centene's contractual and regulatory requirements; collaborates with business owners and/or third parties/subcontractors to drive remediation and assist Centene and third parties/subcontractors to maintain integrity through oversight and monitoring and in meeting Government-sponsored health care program requirements.

• Intakes and triages compliance issues based on defined risk criteria and signs out to other team members as needed.
• Collaborates with compliance and business stakeholders to ensure adequate root cause analysis and development of corrective actions plans to effectively address non-compliance.
• Reviews and oversees progress towards remediation and documented key milestones in GRC tool.
• Identifies issues that require escalation and ensures they are addressed timely through established paths and processes.
• Conducts review of evidence to address root cause of issue and facilitate timely closure of issues.
• Supports corrections reporting that provides meaningful trend analysis for business stakeholders and senior leadership on new, in progress and closed issues as well as regulatory sanctions.
• Educates, encourages, and assists those within the company to maintain integrity through correction of identified non-compliance in order to meet the requirements of Government-sponsored health care programs.
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience:

• Bachelor's Degree Managed Care/Health Insurance or related field; or equivalent experience required
• 3+ years years of experience in Managed Care, Health Care, Health Insurance or related field required
• 1+ years experience in project oversight type role with demonstrated ability to drive implementation and influence others preferred
• 1+ years experience in reading, analyzing, and interpreting State and Federal laws, rules and regulations preferred
• 1+ years experience in State Medicaid or Federal managed care compliance preferred

Licenses/Certifications:
Certified in HealthCare Compliance (CHC) preferred

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act