Senior Manager, Payment Integrity- Provider Experience & Enablement

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose:
The Senior Manager, Payment Integrity Provider Experience and Enablement serves as the strategic leader responsible for elevating the provider experience and strengthening enterprise alignment through the Health Plan Concierge function. This role oversees escalated provider issue management and acts as a critical partner to Network, Health Plans, Claims, and other cross functional teams to ensure that provider impacts of Payment Integrity programs are clearly understood, proactively communicated, and operationally supported. functional teams to ensure that provider impacts of Payment Integrity programs are clearly understood, proactively communicated, and operationally supported.

Through close collaboration with Network and Health Plans, the Senior Manager provides actionable insights related to contracting considerations, provider experience trends, operational readiness, and downstream impacts of Payment Integrity initiatives. The role manages escalations that fall outside traditional dispute pathways, ensuring issues are resolved with accuracy, transparency, and a balanced focus on provider experience and enterprise objectives.

In addition, the Senior Manager leads provider enablement efforts by developing clear, accessible education, training materials, communication resources, and data driven insights that support provider understanding and adoption of Payment Integrity program requirements. By continuously monitoring escalation patterns, market signals, and provider feedback, this leader informs program enhancements, improves process consistency, reduces friction points, and fosters a fair, collaborative relationship between the health plan and the provider community.

• Provides strategic oversight for escalated provider issue management, ensuring timely, accurate, and well-coordinated resolution across Payment Integrity, Network, and Health Plan teams. Drives consistency in approach and accountability across all partners.
• Serves as a primary liaison with Network and Health Plans, ensuring Payment Integrity programs are aligned with provider impacts, operational readiness, and contracting considerations. Influences decision making by proactively identifying downstream impacts and recommending adjustments.
• Develops or coordinates the development of provider-facing education, training materials, and communications , working independently or with appropriate cross-functional stakeholders, to ensure clarity, transparency, and effective program adoption. Establishes and maintains messaging standards and enable partner teams to drive consistent understanding across the network.
• Analyzes provider feedback, escalation themes, and trend data, transforming insights into actionable recommendations that guide program enhancements, remove friction points, and strengthen overall provider relationships.
• Leads and facilitates cross functional triage of complex provider concerns, ensuring aligned decision pathways, consistent messaging, and a unified resolution experience across internal teams. Escalates issues appropriately and oversee end to end management.
• Oversees the creation, organization, and quality assurance of defensible case documentation to support pre litigation reviews, arbitration preparation, and complex provider issue assessments (non legal support), ensuring accuracy, completeness, and audit readiness.
• Evaluates and optimizes end to end processes across Payment Integrity and partner functions to streamline workflow, enhance the provider experience, improve cost avoidance, and strengthen financial recovery performance. Leads continuous improvement efforts and implement scalable solutions.
• Prepares, interprets, and presents reporting and insights to senior leadership, highlighting provider experience trends, escalation patterns, cost avoidance, recovery outcomes, and operational impacts. Provides data driven recommendations that inform decisions and shape enterprise level strategy.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:
Bachelor’s degree in Healthcare Administration, Business, Public Health, Health Information Management, or related field or equivalent work experience required. Master’s degree preferred.

Experience:

• 6+ years of experience in Payment Integrity, Health Plan Operations, Provider Network, Claims, Audit, or related payer functions.
• 4+ years of leadership experience with direct reports
• 4+ years of managing escalated provider issues and collaborating with Network and Health Plans.
• 2+ years of experience with SIU/FWA investigations, provider behavior reviews, documentation development, or fraud/waste mitigation.
• Experience developing provider-facing education, training materials, or communications.
• Experience analyzing trends, interpreting data, and translating insights into operational or program improvements.
• Experience coordinating cross functional workstreams across Claims, Network, Clinical, Legal, Compliance, and Technology.
• Supporting provider contracting teams or contributing contracting insights related to PI programs.

Pay Range: $107,700.00 - $199,300.00 per year

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