Teams at Centene Corporation

Lead analytics for Internal Audit Claims: extract, transform, reconcile, and validate large claims datasets; build and maintain Power BI reports/dashboards; perform QA and tie-outs; support automation, bots/AI enablement, and executive reporting; mentor other analysts and partner with audit, IT, and business stakeholders to deliver repeatable, validated analytics.

Perform detailed reviews of state and corporate payment policies for compliance, analyze coding, reimbursement and regulatory guidelines, develop and maintain payment policies and claims editing logic, support implementations through data analysis and testing, identify process improvements, and coordinate across business units.

Audit pharmacy prior authorization processes and data using MedPharm systems, identify process improvements, support clinical training, maintain audit records, and collaborate with business partners to resolve errors and present recommendations.