Full-Time

Healthcare Operations Auditor

Posted on 5/22/2025

Centene

Centene

10,001+ employees

Health insurance provider for underserved populations

Compensation Overview

$22.79 - $38.84/hr

+ Incentives

Junior, Mid

Florida, USA + 1 more

More locations: Arkansas, USA

Category
Generalist Operations
Quality Control & Compliance
Operations & Logistics
Required Skills
Risk Management
Data Analysis
Requirements
  • Bachelor’s degree in related field or equivalent experience
  • 2+ years of auditing or process improvement experience, preferably in a managed care setting
  • Knowledge of state contract and accreditation requirements
  • Ability to travel
Responsibilities
  • Compile audit findings and report to management, making recommendations for modifications and improvements to operations, systems and procedures
  • Ensure defined goals are implemented and relevant analytics are available to measure goal performance
  • Coordinate auditing outcomes to identify, develop and publish corrective actions and educational material related to audit errors
  • Examine and evaluate information systems, recommending controls to ensure system reliability and data integrity
  • Identify and resolve system issues with data load
  • Research state contract requirements and accrediting body standards and identify areas that present potential risk to the company
Desired Qualifications
  • Experience in a managed care setting preferred

Centene Corporation operates in the healthcare industry, focusing on improving the health of individuals, especially those who are underinsured or uninsured. The company provides a variety of health insurance products and services, including medical, dental, vision, and behavioral health care, primarily through local brands tailored to meet the specific needs of different communities. Centene generates revenue by collecting premiums from its members, which amounted to $140.1 billion in 2023, while serving 27.5 million members. What sets Centene apart from its competitors is its localized approach, allowing it to effectively address the unique health needs of the populations it serves. The company's goal is to enhance health outcomes while managing costs, and it is also committed to corporate sustainability and promoting employee well-being through flexible work arrangements.

Company Size

10,001+

Company Stage

IPO

Headquarters

Saint-Louis, Senegal

Founded

1984

Simplify Jobs

Simplify's Take

What believers are saying

  • Expansion of telehealth services aligns with Centene's cost-effective healthcare mission.
  • AI integration in claims processing enhances efficiency and reduces fraud for Centene.
  • Value-based care models offer Centene opportunities to improve outcomes and control costs.

What critics are saying

  • Increased competition in the Health Insurance Marketplace may erode Centene's market share.
  • Rising pharmaceutical costs could impact Centene's ability to offer cost-effective services.
  • Potential changes in Medicaid funding could affect Centene's revenue streams.

What makes Centene unique

  • Centene focuses on underinsured and uninsured populations, offering tailored healthcare solutions.
  • The company uses a localized approach to meet specific community healthcare needs.
  • Centene integrates social determinants of health into its healthcare services.

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Benefits

Health Insurance

401(k) Retirement Plan

401(k) Company Match

Paid Vacation

Hybrid Work Options

Flexible Work Hours

Company News

PR Newswire
Jun 10th, 2025
Fidelis Care Maternal Health Grant Applications Now Open To Providers And Organizations Across New York State

Grants aim to support innovative strategies in postpartum care and maternal mental health in underserved and vulnerable communitiesLONG ISLAND CITY, N.Y., June 10, 2025 /PRNewswire/ -- Fidelis Care, a statewide health plan with more than 2.4 million members in New York State and a Centene Corporation company, has opened the application process for its 2025 maternal health grant program. The grants, open to healthcare providers and community-based organizations in New York, aim to fund programs that support innovative strategies in postpartum care and maternal mental health. The application is available at fideliscare.org/maternal-grant. The deadline to apply is 5 p.m. July 8, 2025.Postpartum care and maternal mental health are critical components of long-term health and well-being for new mothers and their families. The Substance Abuse and Mental Health Services Administration (SAMHSA) says mental health conditions, including depression and anxiety, are among the most common complications of pregnancy, affecting an estimated one in five individuals annually in the United States

BankInfoSecurity
Jun 4th, 2025
The Forgotten Details of Ransomware Response Plans

Those details include the availability of cyber insurance coverage, incident response teams, ransomware negotiators and other critical aspects of the response that often get overlooked until it's too late, said Doten, who in his role at Centene often works with the company's healthcare customers when they are hit with disruptive cyberattacks.

Health Technology Insights
May 30th, 2025
Health Net, Centene Invest $7.2 Million in CA Mobile Clinic Expansion

Health Net, Centene invest $7.2 million in CA mobile clinic expansion.

PR Newswire
May 14th, 2025
Fidelis Care Awards $149,000 In Behavioral Health Grants To Providers And Organizations Across New York State

Grants of $10,000 to $20,000 aim to improve behavioral health outcomes, especially in underserved communitiesLONG ISLAND CITY, N.Y., May 14, 2025 /PRNewswire/ -- In observance of Mental Health Awareness Month, Fidelis Care, a statewide health plan with more than 2.4 million members and a Centene Corporation company, has awarded $149,000 in behavioral health grants to nine healthcare providers and community organizations across New York State. The grants – ranging from $10,000 to $20,000 – are intended to enhance the integration of behavioral health and primary care through innovative strategies. These efforts aim to bridge care gaps for vulnerable populations by promoting comprehensive support.The 2025 Fidelis Care behavioral health grant recipients are:"The Fidelis Care behavioral health grant program fosters stronger ties with providers and community-based social need service organizations to get people the help they need to live fulfilled lives," said Fidelis Care Vice President and Medical Director Dr. Camille Pearte. "It is fitting that we announce these grants in observance of Mental Health Awareness Month. Fidelis Care is taking meaningful steps to support underserved communities by focusing on and enhancing care coordination for people with mental and behavioral health diagnoses."The Center for Comprehensive Health Practice (CCHP) delivers integrated, multidisciplinary, culturally responsive, and family-centered care to more than 2,200 individuals in New York City's most underserved communities

ES Global
Apr 10th, 2025
Health Net and Centene Foundation Invest More than $9 Million in Initiatives to Expand and Strengthen California's Physician Workforce

Health Net and the Centene Foundation also awarded a $5.5 million grant to the Charles R. Drew University of Medicine and Science to provide full-tuition scholarships, financial support for medical residents and other resources to recruit and retain future doctors.

INACTIVE