• Provide analysis, interpretation, training, and education related to requirements as needed to ensure understanding and effective implementation of compliance requirements • Support departments with requirement implementation, reporting development, policy and procedure development/review, and readiness testing • Collaborate with internal business owners to ensure implementation of the health plan’s business and contractual requirements • Work with Compliance leadership to interpret regulations and provide related guidance • Assist in review and dissemination to team of Regulatory Distribution Management items (new and changing regulations) • Provide Compliance Program support with audit and monitoring, corrective action plan management, data analytics and other projects • Analyze relevant business and/or delegate/FDR performance data to ensure compliance with requirements and prepare reports for leadership and business owners • Proactively use analytic and research skills to identify potential areas of risk • Support and/or coordinate audit activities with impacted business owners to ensure adequate representation from subject matter experts (SME) for external reviews and audits • Proactively maintain documentation, data universes, responses and other written or electronic materials using the proper compliance tools and in accordance with Corporate Compliance protocols • Investigate risks and issues with effective research, root cause analysis, and gap analysis for effective remediation and corrective action management • Build and maintain positive and strategic relationships with internal and external stakeholders • Attend all required implementation meetings and communicate outcomes, manage deliverables, and provide guidance to business areas

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. Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States. Position Purpose: Maintain compliance with program integrity related regulatory laws and standards, while also supporting Program Integrity in maintaining compliance with all other regulatory laws and standards, including HIPAA; program integrity reporting; and assist in developing and implementing program integrity oversight, monitoring and auditing strategies. - Prepare and timely file annual and renewal program integrity filings with various state departments of insurance, state level contract holders, and federal regulators. - Review and analyze state program integrity, including fraud, waste and abuse detection, investigation and prevention requirements. - Review reports for program integrity related regulatory requirements, assess data collection and management processes, and recommend or develop enhancements to optimize accuracy and compliance. - Review and analyze proposed contracts for program integrity reporting and other related requirements. - Assist with maintaining program integrity related policies & procedures to ensure compliance with regulatory laws and standards. - Maintain databases relating to federal and state program integrity requirements and program integrity oversight, including oversight activities, auditing and training. - Assist with facilitation of education of employees regarding program integrity, regulatory oversight and data integrity. - Assist in audits of organization for regulatory oversight of compliance and program integrity related matters. - Create and maintain reports to support contractual and regulatory compliance with program integrity related regulations and requirements. - Performs other duties as assigned. - Complies with all policies and standards. Education/Experience: - Bachelor’s degree in Business, Public Health, Health Care Administration, related field or equivalent experience. - 2+ years in a regulatory, compliance or legal role, preferably in healthcare or in a government agency. License/Certification: Paralegal certificate preferred. 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

• Facilitate, monitor, and evaluate operational effectiveness of risk and control environment • Assist in coordination of SOC and PCI audits • Support ongoing compliance monitoring • Lead compliance-related projects and assist with project management • Manage policy using GRC tooling

EDI Compliance Analyst | 100% Remote (WFH) Opportunity General Summary Under the direct supervision of the Corporate Claims Manager and EDI Supervisor, the EDI Compliance Analyst monitors, coordinates and administers various electronic regulatory reporting processes for the Claims Department. The EDI Compliance Analyst ensures that the regulatory reporting of Claims data, whether electronic or on paper, occurs accurately and within appropriate timeframes in compliance with established internal, State and Federal rules. Essential Duties and Responsibilities - Submits, monitors, and validates electronic transactions for Claims regulatory reporting processes including, but not limited to: - CMS Section 111 Reporting - IAIABC First and Subsequent Reports of Injury (FROI/SROI) for all state jurisdictions - IAIABC Medical Bill EDI Reporting - ISO Child Support Enforcement Agency (CSEA) Program / Child Support Lien Network (CSLN) - NCCI Detailed Claim Information (DCI) Reporting - NV DIR Claim Index Reporting - WCIRB, NCCI, DE, PA, MA, NJ, NY, and WI Medical Data Call Reporting - WCIRB, NCCI, and NY Indemnity Data Call Reporting - UNIT STAT - Handles the error rejection process to ensure complete report submission occurs - When required, assists with the handling of additional electronic and paper data calls received from State and Federal agencies. - Communicates effectively, professionally, and courteously, in writing and verbally, with all internal and external customers. - Provides training to claims staff regarding required claims system data fields to meet state reporting requirements. - Responds timely to external third party reporting vendors and regulatory agencies to resolve reporting issues when needed. - Conducts annual research of both new and existing bureau mandates for EDI reporting requirements to determine if electronic interface updates and/or new report development is required. - Interprets state and federal reporting mandates for the IT Business Analyst and/or Data Analytics report developer to implement new reporting processes. - Assists with testing of new regulatory reports to validate code development is accurate. - Assists with regression testing of existing interface reports when Claims System upgrades or new releases are implemented. - Notifies management of pending issues, production concerns, or when potential changes to reporting procedures or regulations are identified. - Researches the nature of problems, identifies potential solutions, and executes resolution independently when appropriate. - Meets quality, accuracy and productivity objectives and goals for error correction with minimal assistance and/or guidance and prevents reporting penalties. - Other duties as assigned. Requirements - Minimum 5 years experience in the Workers’ Compensation or P&C industry working with claims data, experience in electronic regulatory reporting preferred, or 3 years in a related field. - A working knowledge of insurance principles as related to the applicable state-specific reporting rules, federal reporting rules, IAIABC reporting standards, internal system triggers, and reporting timeframes to ensure compliance and penalty avoidance. - Must have excellent computer skills and working knowledge of Microsoft Office, Outlook, Word, and Excel. - Must have excellent verbal, written, and interpersonal skills. - Must be process oriented with great attention to detail. - Must be able to manage and appropriately prioritize multiple tasks at the same time. - Must be detail oriented and capable of working with minimal supervision. Education - Must have High School Diploma or GED equivalent. - Equivalent combinations of education and experience may be considered. Work Environment - Remote: This role is a remote (work from home (WFH) opportunity) and only open to candidates currently located in the United States and able to work without sponsorship. - It requires a suitable space that provides a private and quiet workplace. - Expected Work Hours: Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. - Travel: May be required to travel to off-site location(s) to attend meetings, as necessary - Hourly Pay Range: $26.00/hr - $35.00/hr and a strong comprehensive benefits package, don't forget to follow the link to our benefits page for details, too many benefits to list! EMPLOYERS Benefits About EMPLOYERS As a dynamic, fast-growing provider of workers' compensation insurance and services, we are seeking a goal-oriented individual willing to put their ideas to work! We offer a positive, challenging work environment, combined with an opportunity to build your career as you help us grow our business, in innovative and imaginative ways that are uniquely EMPLOYERS! Headquartered in Nevada, EMPLOYERS attributes its long-standing success to its most valuable resource, our employees across the United States. EMPLOYERS is known for the quality service and expertise we provide to our clients, and the exemplary work environment we provide for our employees. We live and breathe our core values: Integrity, Customer Focus, Collaboration, Initiative, Accountability, Innovation, and Personal Fulfillment. These are the pillars that support how we do business with our clients as well as how we treat each other! At EMPLOYERS, you’ll discover an energetic environment that inspires top achievement. As “America’s small business insurance specialist”, we have the resources, a solid reputation and an expanding nationwide identity to enrich your work/life and enhance your career. #LI-Remote About EMPLOYERS