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 Purpose: Leads day-to-day operations for a team of Sales Investigators and Senior Sales Investigators responsible for investigating allegations of sales agent, agency, broker, and related sales-practice misconduct. Serves as the first-line people leader accountable for risk-based case assignment, investigative quality, timeliness, and consistent application of established standards. Ensures investigative work is documented in a clear, complete, and defensible manner and that team outputs are aligned with internal policies, CMS requirements, and audit/regulatory expectations. Partners with Compliance leadership, Legal, Sales, HR, and other stakeholders to address case-specific issues, implement corrective actions, and escalate systemic or high-risk concerns.
- Manage Compliance Investigations Unit ("CIU") staff, ensuring timely, accurate, complete, professional, and ethical investigations, investigatory reports, and remediation.
- Manage investigations resulting from allegations of misconduct reported to Compliance department, consulting with the Director to determine the need for escalation for each such report and ensuring timely, appropriate resolution of matter. Ensures that reports are referred to other business areas, including Legal and HR, as appropriate for inquiry by such department. Prepare summary reports and analyze trends or patterns resulting from allegations of misconduct. Assist director in preparing reports regarding investigations for senior management and the board of directors.
- Collaborate with other corporate business owners and market staff in obtaining information necessary for investigations, and in remedying issues that may be causing compliance concerns.
- Develop various aspects of corporate compliance training materials. Create and maintain investigatory policies and procedures.
- Responsible for the CIU's meeting all response deadlines imposed by federal and state requirements.
- Supervise and develop investigatory staff.
- Performs special projects and other duties as assigned.
Candidate Education:
- A Bachelor's Degree in Criminal Justice, Law, Compliance, Healthcare Administration, or related field required or Associates with 6 years of applicable experience, or a High School/GED with 7 years of applicable experience may substitute for the Bachelors Degree
- 5+ years of progressive experience in compliance, investigations, SIU, FWA, audit, or related functions in managed care, healthcare, or another similarly regulated environment required.
- 1+ year of experience in leading or managing others required.
- Demonstrated experience reviewing investigative work product for quality, evidentiary sufficiency, and defensibility required.
- Demonstrated experience coordinating cross-functional case activity and remediation with business stakeholders required.
Preferred Qualifications
- 2+ years of direct people leadership.
- Managed care or health plan experience.
- Experience supporting audit responses, regulatory inquiries, or oversight reviews.
- Working knowledge of Medicare sales and marketing compliance expectations, including CMS Chapter 42 and related CMS marketing guidance.
- Professional certification such as CFE, AHFI, CIA, CHC/HCCA, CCP, or similar.
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
