Senior Compliance Oversight Specialist

This is a fully remote position, open to applicants in Missouri.

📋 Description

• Engage in the auditing, monitoring, and oversight of Centene's ethics and compliance program, as well as those of partners, subsidiaries, and third-party subcontractors.

• Execute audit, oversight, and monitoring activities to evaluate adherence to contractual and regulatory standards.

• Collaborate with various stakeholders to facilitate remediation efforts and ensure compliance with requirements of government-sponsored health care programs.

• Provide education to brokers regarding audit results, program requirements, policies, and procedures.

• Develop and present corrective action plans; oversee probationary periods and disciplinary measures.

• Prepare formal written reports detailing audit, oversight, and monitoring findings along with recommendations.

• Direct compliance-related issues to the appropriate channels for investigation and resolution.

• Assess the status and effectiveness of corrective action plans, track issues through remediation and closure, and ensure follow-up actions are taken.

• Foster awareness of the Enterprise Ethics and Compliance Program and associated policies and procedures.

• Assist in the development and maintenance of monitoring and auditing tools.

• Support state Medicaid annual work plans and initiatives from OIG/CMS across claims, credentialing, network management, and customer service.

• Aid in evaluating new and updated government-sponsored health care program contracts and requirements.

• Support Health Plans, Subsidiaries, Shared Services, and Third Parties/Subcontractors in recognizing and assessing compliance risks.

• Serve as a compliance advisor to business units and third parties, covering areas such as claims/payments, credentialing, network management, and financial solvency.

• Perform additional duties as assigned while adhering to all policies and standards.

⛳️ Requirements

• A Bachelor's Degree in Healthcare, Audit, Business, or a related field, or equivalent experience is required; a High School diploma/GED combined with 5+ years of relevant experience is also acceptable.

• CHC - Certified Healthcare Compliance certification is preferred.

• Certified Internal Auditor (CIA) designation is preferred.

• Proven experience in auditing, monitoring, and oversight of corporate ethics and compliance programs.

• Familiarity with contractual and regulatory requirements as well as government-sponsored health care program requirements.

• Strong capability to collaborate with business owners, brokers, distribution partners, subsidiaries, and third-party subcontractors.

• Proficiency in developing and monitoring corrective action plans.

• Ability to evaluate compliance risks and regulatory compliance challenges.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans.

• Tuition reimbursement opportunities.

• Paid time off in addition to holidays.

• Flexible work arrangements, including remote, hybrid, field, or office schedules.

• Additional incentives may be included in total compensation.

• An equal opportunity employer that is committed to diversity.