Program Manager III - SIU Intelligence & Innovation

Position Purpose: This role is critical to advancing SIU’s Intelligence & Innovation strategy through the design, development, and execution of proactive fraud detection, analytics, and investigative intelligence programs. The position serves as a key driver in identifying emerging fraud risks, transforming complex data into actionable intelligence, and delivering innovative solutions that enhance SIU’s effectiveness, operational efficiency, and enterprise value.

• Supports the strategic planning, development, and execution of SIU proactive anti-fraud detection, tools and analytics programs, initiatives, and priorities to strengthen the SIUs Intelligence & Innovation operations.
• Transforms large and complex data sets into defensible, actionable analytical insights that support investigative lead generation, case development, fraud prevention initiatives, and data-driven decision-making while ensuring compliance with enterprise governance standards and regulatory requirements.
• Leverages advanced analytical resources, including HCFS PostShield, AI Shield, Pharmacy Shield, and other internal and external data assets, to identify emerging risks, develop innovative detection strategies, and continuously enhance proactive fraud identification capabilities.
• Partners with SIU leadership and enterprise stakeholders to design and implement advanced analytical methodologies, predictive monitoring solutions, dashboards, performance metrics, and reporting capabilities that support strategic priorities and operational excellence.
• Collaborates across SIU, Claims, Configuration, IT, Clinical, Compliance, Market Operations, and external partners to communicate program objectives, manage priorities, mitigate risks, resolve barriers, and drive measurable Intelligence & Innovation outcomes.
• Researches, evaluates, and monitors emerging fraud schemes, industry trends, regulatory developments, and analytical opportunities to continuously improve detection methodologies and investigative effectiveness.
• Communicates analytical findings, fraud trends, program performance, financial impact, risks, and strategic recommendations to senior leadership and key stakeholders through executive-level presentations, reporting, and data storytelling.
• Maintains comprehensive, audit-ready documentation, including program roadmaps, governance artifacts, risk and decision logs, methodology documentation, claim volume analyses, performance metrics, and financial impact reporting.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

• Bachelor's Degree in Business Administration, Healthcare Administration, or related field, or four (4) years of equivalent experience required.
• 5+ years of program, project, or product management experience required.
• Experience related to healthcare fraud, analytics, investigations, project management, data science, or other related healthcare environments preferred.
• Preferred credentials: CFE, AHFI, CHC, PMP, SAS, CPC.

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.
 

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