Lead Payment Integrity Systems Specialist

• Lead enterprise-level analysis of complex Payment Integrity system, claims, workflow, financial, and reporting data to 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, aligning Operations, Technology, Finance, governance, and leadership stakeholders on scope, impact, risk, decisions, and readiness.
• Own operating routines that prioritize and govern incidents, defects, enhancements, releases, automation opportunities, and modernization workstreams across Payment Integrity systems.
• Translate complex cross-platform results into executive-ready summaries, strategic recommendations, implementation plans, and measurable success criteria.
• Advise leadership on platform governance, financial reporting considerations, data quality controls, process standardization, and long-term system capability needs.
• Lead the design and 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.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:
Bachelor's Degree in healthcare, business, finance, accounting, information systems, data analytics, or a related field, or equivalent experience required.
5+ years 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. preferred.
Experience setting platform governance, operational visibility standards, dashboard/reporting strategy, release-readiness routines, and cross-functional technology operating models. preferred.

License/Certification:

• Advanced credentials in data analytics, business analysis, healthcare data, project/program management, Lean Six Sigma, finance/accounting, SQL, or related systems disciplines. preferred
• License/Certification: LPN, RN, CPC, CPC-H, CPC-P, CCS, CCS-P, RHIT, RHIA, or CPMA. RHIT, CCS, CIC, CCDS. preferred

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 the workday.
 

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