[Remote] Compliance Oversight Specialist (Non Clinical)

Note: The job is a remote job and is open to candidates in USA. Centene Corporation is a diversified, national organization focused on transforming the health of its communities. The Compliance Oversight Specialist participates in oversight of corporate ethics and compliance programs, conducts compliance reviews and monitoring, evaluates risks and corrective actions, and collaborates with stakeholders and delegated subcontractors to address regulatory requirements.

Responsibilities

• Collaborates with and assist those within the Company and the Company’s delegated subcontractors to maintain integrity through oversight and monitoring and in meeting the requirements of our executed contracts with Government-sponsored health care programs
• Assists in the assessment of new and amended Government-sponsored health care program contracts and requirements
• Assists Markets (local), Shared Services (corporate), and/or delegated subcontracts in the identification and assessment of compliance risks
• Evaluates the effectiveness of Market (local), Shared Services (corporate), and/or delegated subcontractor compliance programs and related policies and procedures designed to promote legal and ethical compliance
• Prepares accurate and timely formal written reports on oversight and monitoring activity findings and recommendations and ensure workpapers are properly prepared in accordance with WellCare and departmental standards, including sufficient evidentiary material exists to support oversight and monitoring activity findings
• Collaborates with other departments and/or delegated subcontractors to direct compliance issues to appropriate channels for research and resolution
• Reviews and evaluates the status and effectiveness of corrective action plans and provide comprehensive follow up to stakeholders, Senior Management, Market Compliance Oversight Committees, and/or the Audit, Finance, and Regulatory Compliance Committee of the Board of Directors
• Participates in special projects as needed, including training
• Performs other duties as assigned
• Complies with all policies and standards

Skills

• A Bachelor's Degree in Related field, or Associates with 4 years of applicable experience, or HSD/GED with 5 years of applicable experience in lieu of Bachelor's degree
• Required 3+ years of experience in Managed Care/Health Insurance
• 1+ year of experience in project oversight type role with demonstrated ability to drive implementation and influence others
• 1+ year of experience in reading, analyzing, and interpreting State and Federal laws, rules and regulations
• 1+ year of experience in State Medicaid or Federal managed care compliance
• Certified in HealthCare Compliance (CHC) preferred

Benefits

• Health insurance
• 401K
• Stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• A flexible approach to work with remote, hybrid, field or office work schedules

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