- Business Area: Quality
- Job Type: Full time
- Date Posted: Jun 22 2026
- Job Number: 1642035
This job is available in 2 locations
- Remote-MO
- Remote-TX
**Keywords**
Clinical Investigator I (Special Investigation Unit)
Apply Now
Share
**Description**
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 IS REMOTE NATIONWIDE\*\*\*
- LOOKING FOR CANDIDATE WITH CPC OR CPMA CERTIFICATION\*\*\*
**Position Purpose**
Audit medical records to identify inappropriate billing practices and recommend next steps through extensive review of claims data, medical records, corporate policy, state/federal policy, and practice standards.
- Perform retrospective and prepayment reviews of medical records to identify potential abuse and fraud and inappropriate billing practices
- Investigate, analyze, and identify provider billing patterns to recommend payment based on medical records, claim history, billing codes, regulatory and state guidelines, and policies
- Prepare summary of findings and recommend next steps for providers
- Identify preventative measures and recommend changes to internal policies and procedures and/or provider practices to prevent future fraudulent and erroneous practices
- Consult investigators to identify abuse and fraud by utilizing clinical and coding expertise to analyze patterns in billing activities
- Performs other duties as assigned.
- Complies with all policies and standards.
**Education/Experience**
Associate's Degree related field or equivalent experience preferred
2+ years related clinical experience in the field of obtained license required
Provider education preferred
**Licenses/Certifications**
Coding certification from an accredited organization (American Academy of Professional Coders or American Health Information Management Association), RN, LPC, LPN, LCSW, LMHC, PT, OT, or ST or related license. required
Pay Range: $56,200.00 - $101,000.00 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
Healthcare Quality Improvement Jobs
Jobs in Missouri
Through Home State Health Plan, Centene provides quality-focused, affordable healthcare delivered locally. Also, Missouri is home to Centene's Corporate Headquarters.
Jobs in Texas
Centene first established operations in Texas in 1999. Through Superior Health Plan, Centene provide quality-focused, affordable healthcare delivered locally.
Similar Jobs
Clinical Investigator - Behavioral Health
- Remote-MO + 5 other locations
- Administrative & Claims Operations
Manager, SIU Prepay Investigations
- Remote-MO + 9 other locations
- Legal & Compliance
SIU Investigator
- Remote-MO + 8 other locations
- Legal & Compliance
Play video
Working at Centene
Wondering what it’s like to work at Centene? Hear from our team.
Meet our team
Join Our Talent Network
Connect with our Talent Attraction team, explore current job openings, and stay up to date on the latest at Centene.
Join
