Supervisor, Ethics & Investigations Intake Triage

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: Supervises Intake/Triage operations to ensure accurate, timely, and compliant intake, documentation, and reporting of referrals supporting investigative and compliance related business functions. Accountable for day-to-day team performance, adherence to internal policies, and compliance with applicable state and federal regulatory requirements.

• Supervise daily Intake/Triage operations, including referral assignment, workload prioritization, quality review, and timely completion of intake activities in accordance with established policies, procedures, and regulatory timelines.
• Provide direct supervision, coaching, and performance feedback to Intake/Triage staff; identify training needs and develop or maintain training aids, job aids, and step-by-step process documentation.
• Ensure intake documentation is complete, accurate, and audit ready, including appropriate classification, escalation, and tracking of referrals related to Centene operational areas and state/federal expectations.
• Monitor team performance metrics; identify trends, risks, and capacity concerns; and report findings to management with recommendations for corrective action.
• Serve as an escalation point for intake issues, including complex referrals, timeliness concerns, data quality issues, and process deviations, and coordinate resolution with management and internal stakeholders as appropriate.
• Collaborate with compliance, investigative, and operational partners to address intake findings, support corrective action planning, and implement process improvements.
• Track assigned projects or initiatives, anticipate risks to timelines or objectives, and implement mitigation strategies to ensure successful completion.
• Ensure team adherence to confidentiality, privacy, and data protection standards, including HIPAA and other applicable regulations.
• Maintain documentation and records in accordance with internal retention requirements and audit standards.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience:

• Bachelor's Degree Business, Healthcare, Criminal Justice, or related field; or equivalent experience required
• 3+ years Management experience in Healthcare, Compliance, or Fraud Investigation required
• 2+ years Management experience in a supervisory or team lead role, preferably within a managed care or healthcare setting required
• Demonstrated knowledge of healthcare regulatory requirements, including CMS, HIPAA, Medicare/Medicaid, and applicable state regulations required
• Prior experience leading teams, managing workloads, and supporting cross functional initiatives or projects preferred
   

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