Vice President, Special Investigations Unit - Remote

Overview

Centene is transforming the health of our communities one person at a time. As an Executive on our team, you could be the one who changes everything for our 28 million members.

In Short

• Lead a team dedicated to detecting, preventing, and correcting fraud, waste, and abuse (FWA) in healthcare billing.
• Design and execute strategies for high-quality, timely FWA investigations.
• Collaborate with internal and external stakeholders including law enforcement.
• Develop a forward-looking FWA investigation strategy aligned with regulatory obligations.
• Oversee the intake and resolution of suspected FWA cases.
• Implement technology and analytics tools to identify risk patterns.
• Establish KPIs and operational dashboards to monitor performance.
• Maintain documentation and governance frameworks for SIU operations.
• Stay updated on FWA-related developments in the healthcare industry.
• Represent the SIU at audit and regulatory meetings.

Requirements

• Bachelor’s degree in business administration, Healthcare Administration, Law, or related field required.
• 10+ years of experience in fraud investigations or healthcare compliance required.
• Significant experience managing large-scale FWA programs required.
• Deep knowledge of federal and state health programs and FWA regulatory frameworks required.
• Proven leadership experience with cross-functional teams required.
• Strong data literacy and familiarity with fraud analytics tools required.
• Excellent executive communication and risk judgment skills required.
• Experience leading SIU operations in a managed care organization preferred.
• Track record of innovation in fraud detection preferred.
• CFE or AHFI certification preferred.

Benefits

• Competitive pay.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• Flexible work schedules.