Payment Integrity Systems Specialist II

• Conduct moderately complex analysis of Payment Integrity platform outputs, claims system data, edit/rule behavior, financial/reporting outputs, and workflow performance to identify exceptions, trends, and operational impacts.
• Manage moderately complex ServiceNow or similar incidents, defects, enhancement requests, and intake items by documenting requirements, tracking status, coordinating follow-up, and escalating blockers.
• Coordinate UAT, regression testing, validation, and release-readiness activities for system changes, including defect validation and communication of operational impacts.
• Develop and maintain dashboards, trackers, recurring reports, and workstream visibility tools for platform enhancements, defects, metrics, savings opportunities, and operational improvement initiatives.
• Gather and analyze data using Excel, SQL, Power BI, financial reporting tools, or approved reporting platforms to validate outputs and support decision-making.
• Partner with Operations, Technology, Finance, governance/delivery, and business stakeholders to clarify requirements, document decisions, and support transformation workstreams.
• Apply consistent standards and methodologies to improve data quality, documentation, process consistency, and operational readiness.
• May provide informal guidance or onboarding support to less-experienced 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. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

2+ years of relevant experience in Payment Integrity systems, managed care claims systems, data analytics, financial reporting, business analysis, platform support, quality assurance, UAT, or related technical healthcare function. required.
Working knowledge of managed care claims, Payment Integrity concepts, system workflows, reporting, and operational controls. required.
Experience with ticketing, UAT/testing documentation, dashboards, workflow tracking, data validation, and cross-functional issue resolution. required.
Working proficiency with Excel and developing proficiency with SQL, Power BI, financial reporting tools, or similar data/reporting platforms. required.
Platform Support & Governance required.
Data Validation & Reporting required.
Defect & Enhancement Intake required.
UAT / Regression Testing 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.
Experience with Payment Integrity platforms, claims systems, ServiceNow, Power BI, edit/rule configuration, workflow automation, or platform modernization workstreams. preferred.
Working knowledge of financial systems, accounting principles, and operational financial reporting preferred. preferred.

License/Certification:

• Credentials or training in Power BI, SQL, business analysis, Lean Six Sigma, healthcare data analytics, project coordination, or coding/claims concepts where relevant. preferred
• 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